TRAINING  AND 

REWARDS  OF  THE 

PHYSICIAN 

SICKARD  C.CABOT  M.D. 


~ 


TRAINING  AND  REWARDS 
OF  THE  PHYSICIAN 


Louis  Pasteur. 


LIPFINCOTT'S   TRAINING    SERIES 

/TRAINING  AND  REWARDS 
OF  THE  PHYSICIAN^ 


\  ° 

-> 

R.  c.  CABOT,  M.D. 

AUTHOR  OP  "WHAT  MEN  LIVE  BY' 


PHILADELPHIA  &  LONDON 

J.  B.  LIPPINCOTT  COMPANY 


A 

Cvu* 


COPYRIGHT,    IplS,   BT   J.    B.    LIPPINfOTT   COMPANY 


PUBLISHED   JANUARY, 


PRINTED  BY  J.    B.   LIPPINCOTT  COMPANY 

AT  THE  WASHINGTON  SQUARE  PRESS 

PHILADELPHIA.   U.  8.  A. 


CONTENTS 

PART  I. 

THE  PREPARATION  OF  THE  PHYSICIAN 

CHAPTER  PAGE 

INTRODUCTION 13 

I.  THE   PROFESSIONAL   TYPE    OF   DOCTOR 

AND  THE  PREPARATION  FOR  IT 18 

II.  THE  TRAINING  OF  THE  FAMILY  PHYSICIAN  37 

III.  PREPARATION  FOR  PUBLIC  HEALTH  WORK  60 

PART  II. 

HELPS  AND  HINDRANCES  IN  THE  DOCTOR'S 
DEVELOPMENT 

IV,  CONDITIONS  OF  FAILURE  IN  PRACTICE.  .     69 
V.  FACTORS  OF  SUCCESS 79 

VI.  THE  CHANCE  FOR  THE  YOUNG  DOCTOR.  .     84 
VII.  CITY  PRACTICE  vs.  COUNTRY  PRACTICE    91 
VIII.  THE  INFLUENCE  OF  DRUGLESS  HEALING, 
CHRISTIAN  SCIENCE,  OSTEOPATHY  AND 
OTHER  SPECIAL  CULTS  ON  DEVELOP- 
MENT AND  SUCCESS  OF  THE  DOCTOR.  .       96 

IX.  THE  INFLUENCE  OF  IMPORTANT  PUBLIC 
HEALTH  "CRUSADES"  ON  MEDICAL 
DEVELOPMENT  AND  MEDICAL  PRACTICE  105 


8  CONTENTS 

X.  THE  HEALTH  CRUSADES  AGAINST  TY- 
PHOID, MALARIA  AND  OTHER  PRE- 
VENTABLE DISEASES 120 

XI.  THE   PRIVATE   PRACTITIONER'S   COMPE- 
TITION WITH  GROUP   MEDICINE 123 

PART  in. 

THE  REWARDS 
XII.  THE  REWARDS  OF  MEDICAL  WORK  .        .   133 


ILLUSTRATIONS 


PAQl 


Louis  Pasteur Frontispiece 

Types  of  Prescription  Writing 38,  39 

Considered  the  best  in  the  city  with  one  exception  (1911). 

Selling  100  gallons  of  milk 62 

Same  plant,  modern  and  sanitary  in  every  respect  (1915). 

Selling  1000  gallons 64 

A  Clinic  of  Dr.  Agnew 70 

Playthings — an  aid  in  the  office  when  examining  young 

children 116 

A  Mosquito-map  of  New  Orleans;   fly  maps  should  be 

made  in  the  same  way 121 


PART  I 

THE     PREPARATION     OF     THE 
PHYSICIAN 


TRAINING  AND  REWARDS 
OF  THE  PHYSICIAN 

INTRODUCTION 

ON  a  recent  transcontinental  trip,  a  Pull- 
man car  porter  seeking  medical  aid  for  one 
of  our  fellow  passengers,  accosted  me  with 
the  surprising  question:  "Aren't  you  a 
doctor,  sir?"  *  Yes,"  I  answered,  "  but  how 
did  you  guess  it?"  '  Well,  I  can  most  al- 
ways tell  'em  by  the  looks,"  he  said,  but  he 
could  analyse  his  methods  no  further.  Was 
it  the  result  of  the  doctor's  training  which  the 
porter  supposed  he  could  recognize  ?  I  fancy 
not.  A  certain  type  of  men,  I  think,  is  at- 
tracted into  the  profession  of  medicine,  just 
as  another  type  of  man  is  attracted  into  the 
ministry.  Those  who  answer  medicine's  pe- 
culiar call  have  certain  traits  in  common. 
Thus  it  is,  I  believe,  the  raw  -material  rather 
than  its  preparation  that  determines  most  of 
a  doctor's  recognizable  make-up. 

As  one  recalls  the  notably  successful  doc- 
is 


TRAINING  OF  THE  PHYSICIAN 

tors  in  one's  acquaintance,  is  it  not  obvious 
that  their  successful  attack  upon  their  pro- 
fessional problems  is  due  mostly  to  native, 
inborn  qualities?  Preparation,  training  do 
something  also,  but  they  seem  to  me  minor 
factors.  It  is  among  the  unsuccessful  doctors 
that  the  professional  manner  and  the  tricks 
of  the  trade  are  apt  to  stand  out.  Surveying 
the  doctor  as  a  finished  product  I  conclude 
that  he,  as  a  "  going  concern,"  makes  good 
largely  by  the  social  tact,  the  persistence,  the 
ingenuity,  the  "  horse  sense  "  that  are  born 
in  him  or  bred  into  his  pre-professional 
boyhood. 

However,  training,  especially  the  trainer, 
counts  for  something.  Prolonged  daily, 
intimate  contact  with  teachers  or  medical 
"  chiefs  "  whose  character  has  a  clear  outline 
and  a  strong  color  may  influence  a  medical 
student  for  life.  And  such  contact  is  not  im- 
possible in  medical  training  now  that  the  bad 
old  custom  of  teaching  by  lectures  is  being 
supplanted  by  better  methods.  One  learns 
medicine  as  one  learns  philosophy,  carpentry 
or  book-keeping,  in  two  ways : 

14 


INTRODUCTION 

(a)  By  practising  it. 

(b)  By  imitation  of  good  models. 

In  medicine  the  "  gold  models  "  are  easier 
to  find  and  to  watch  than  in  most  other 
fields  of  work.  Hence,  in  the  preparation  of 
the  doctor,  his  native  outfit  of  talents  and 
sympathies  has  a  good  chance  to  be  increased 
by  something  beyond  what  he  discovers  for 
himself  in  practice.  That  "  something  "  is 
the  ideals  of  teachers  whom  he  admires  for 
competence  or  brilliance  in  his  own  chosen 
field.  These  ideals  may  be  good  or  bad,  but 
in  any  case  they  are  apt  to  become  implanted 
in  the  student  and  to  influence  his  behavior 
for  good  or  evil. 

This  result  is  especially  common  when  a 
group  of  teachers  reenforce  each  other's  in- 
fluence upon  the  student.  The  "  spirit  "  of 
Johns  Hopkins,  the  "  traditions  "  of  Guy's 
Hospital,  the  "  atmosphere  "  of  the  Massa- 
chusetts General  Hospital  are  powerful  com- 
posite influences  made  possible  by  the  group- 
ing of  like-minded  teachers.  Especially 
when  the  world's  counter-currents  are  ex- 
cluded as  in  a  monastic  life,  a  military 

15 


TRAINING  OF  THE  PHYSICIAN 

school  or  a  medical  teaching  group  character 
change  is  actually  wrought. 

The  sort  of  trainers  to  whose  influence  a 
medical  student  should  try  to  expose  himself 
depends  on  what  type  of  physician  he  wants 
(or  hopes)  to  be.  In  the  end  he  will  fall  into 
one  of  four  groups : 

(a)  The    research-and-teaching    man,— 
"  the  professor," 

(b)  The  old-fashioned  family  physician, 
— guide  and  counsellor  to  his  town, 

(c)  The  expert  middle-man  or  special- 
ist who  becomes  an  efficient  machine   for 
applying  in  diagnosis  and  therapeutics  the 
science  worked  out  by  men  of  type  a.    This 
group  includes  men  who  practice  general 
medicine  as  consultants ;  it  includes  also  those 
who  confine  their  work  to  surgery,  obstetrics, 
nervous  disease  or  one  of  the  other  recog- 
nized "  specialties." 

( d)  The  public  health  officer  or  sanitary 
engineering  type  of  physician. 

I  recognize  that  it  may  be  difficult  or  im- 
possible for  a  student  to  know  in  advance 
which  of  these  parts  he  wants  to  play.  But 

16 


INTRODUCTION 

this  objection  applies  also  to  the  choice  of 
medicine  itself.  How  can  a  man  prepare  for 
medical  study  if  he  doesn't  know  until  the 
last  minute  that  he  is  going  to  study  medicine 
at  all? 

The  answer  is  that  some  men  do  know. 
For  them  this  book  is  intended.  For  them 
it  may  also  be  possible,  when  confronted  with 
a  description  of  four  medical  types,  to  recog- 
nize in  one  of  them  the  fruition  of  their  own 
budding  ambitions.  Then  they  can  seek  it. 


17 


CHAPTER  I 

THE  PROFESSIONAL  TYPE  OF  DOCTOR  AND 
THE  PREPARATION  FOR  IT. 

IN  Germany,  Austria  and  Russia  the 
"  Herr  Professor  Doktor "  is  a  figure  so 
well-known  that  immigrants  from  those 
countries  are  prone  to  ask  for  him  when 
seeking  medical  assistance  in  America.  He 
attaches  himself  to  some  university  at  a  mod- 
est initial  salary  and  looks  for  promotion 
within  or  outside  his  university  as  a  reward 
for  production;  i.e.,  for  researches  pur- 
sued and  published.  Within  the  past  ten 
years  American  medical  schools  have  grown 
accustomed  to  the  idea  of  calling  men  from 
other  cities  to  a  medical  teaching  position. 
Formerly  these  positions  were  all  filled  by 
the  "  favorite  sons  "  of  the  locality.  Indeed 
it  could  not  be  otherwise  since  little  or  no 
salary  was  paid  to  medical  professors.  The 
chairs  were  sought  and  filled  because  of  the 
prestige  and  influence  attached  to  them  and 

18 


THE  PROFESSIONAL  TYPE  OF  DOCTOR 

the  professor  was  not  supposed  to  give  much 
time  to  his  work.  He  continued  his  practice 
and  did  his  teaching  "  on  the  side." 

Of  late  years,  however,  about  a  dozen 
American  universities  have  begun  paying 
decent  salaries  to  medical  professors.  In 
view  of  this  the  universities  now  expect  both 
clinical  and  non-clinical  teachers  to  give  full 
time  or  at  least  a  large  and  definite  fraction 
of  their  time  in  return.  This  makes  it  possi- 
ble to  call  the  best  man  in  sight  from  any  part 
of  the  country.  The  salaries  are  not  large, 
but  they  are  secure  and  eliminate  the  worry 
of  financial  uncertainty  which  weighs  so 
heavily  on  the  majority  of  practicing  physi- 
cians today. 

The  duties  of  a  professor  are  four:  1. 
teaching;  2.  research  and  writing;  3.  the 
stimulation  and  supervision  of  other  men's 
research;  4.  administrative  work  and  com- 
mittees. 

In  preparation  for  the  most  important  of 
these  duties  the  student  should  develop  his 
scientific  appetite  by  the  cultivation  of  the 
auxiliary  medical  sciences — physics,  chemis- 

19 


TRAINING  OF  THE  PHYSICIAN 

try  and  biology,  not  in  an  attempt  to  gain 
mastery  of  them  but  to  catch  their  spirit.  For 
it  is  a  common  impulse  that  runs  up  through 
these  sciences  to  medicine  itself,  and  one  who 
nourishes  this  impulse  in  any  natural  science 
will  find  it  applicable  to  medical  problems  as 
well. 

The  fire  of  curiosity,  as  to  how  nature 
works  can  be  started  in  physics  or  biology 
and  later  will  fasten  itself  on  medical  or 
physiological  problems  with  heat  unabated. 
Urgent  curiosity  about  any  natural  science 
is  usually  not  a  natural  but  an  acquired 
taste,  because  it  is  unworldly,  or,  as  we  say, 
"  unpractical."  There  is  no  money  and  no 
fun  in  it.  It  means  work  and  its  goal  is  not 
at  all  obvious  at  the  start.  Nevertheless  curi- 
osity, like  most  instincts,  is  developed  by  use. 
When  once  you  get  started  on  a  hunt  for  the 
understanding  and  mastery  of  nature,  the 
hunt  itself  soon  becomes  fascinating.  To 
find  what  is  just  out  of  sight, — around  the» 
next  corner,  becomes  almost  a  passion  when 
our  blood  is  up  and  the  chase  is  under  way. 
It  is  the  exploring  instinct,  not  easily  set  in 

20 


THE  PROFESSIONAL  TYPE  OF  DOCTOR 

motion  but  hard  to  stop  when  once  it  has 
gathered  speed. 

It  is  most  often  started  (like  disease)  by 
contact  with  some  one  who  has  it  already. 
Hence  during  the  college  period  a  boy  should 
try  to  "  get  next "  to  a  really  enthusiastic 
professor  of  natural  science — in  any  branch. 
It  matters  little  what  science  is  studied.  But 
it  matters  vastly  to  find  the  genuine  enthusi- 
ast. He  need  not  be  a  good  teacher — nor 
even  a  teacher  at  all.  He  may  be  a  fellow- 
student.  But  he  must  have  a  quite  miracul- 
ous fire  of  zeal,  a  zest  not  explainable  by  any 
of  the  common  "  sensible  "  motives  such  as 
earning  one's  living  or  doing  good  in  the 
world,  or  having  a  good  time  or  becoming 
the  boss.  In  short  he  must  be  one  who  acts 
from  "  queer  "  motives  and  pursues  intangi- 
ble ends. 

To  see  anyone  very  hotly  in  pursuit  of 
something, — a  thief,  a  fire  engine — no  matter 
what, — will  often  make  us  drop  our  sensible 
tasks  and  join  in  the  chase  even  though  we 
are  but  vaguely  aware  of  the  quarry.  This 
is  as  true  of  scientific  pursuits  as  of  humbug 

21 


TRAINING  OF  THE  PHYSICIAN 

or  hunting.  In  the  beginning,  at  any  rate, 
we  are  not  after  Truth  or  any  such  abstrac- 
tion. We  want  to  find  out  the  working  of 
some  piece  of  nature  as  we  want  to  take  a 
clock  to  pieces  and  see  what  is  inside.  Con- 
cealment, the  baffling  of  aroused  curiosity 
and  the  desire  to  master,  all  contribute  to 
keep  us  busy  until  habit  begins  to  get  hold  of 
us  and,  like  a  balance  wheel,  to  swing  us 
along  when  spontaneous  energy  lapses. 

College  boys  who  catch  the  scientific  fever 
from  some  adjacent  enthusiast,  are  apt  (if  the 
enthusiast  is  a  man  of  real  power)  to  become 
interested  in  him  as  well  as  in  his  experi- 
ments. Thus  the  scientific  habit  of  mind  is 
brought  more  or  less  within  a  boy's  ken,— 
first  as  a  strange,  austere  and  forbidding 
habit,  but  later  as  the  completed  image  and 
fulfilment  of  what  his  own  mind  is  trying  to 
be.  Thus  as  an  athlete  attracts  younger 
boys,  the  mature  lover  of  natural  science  be- 
comes the  model  on  which  a  student  forms 
himself. 

What   qualities   will   the   undergraduate 
find  in  the  scientific  investigator? 

22 


THE   PROFESSIONAL  TYPE   OF  DOCTOR 
1.    THE  EXPLORING  INSTINCT 

A  hunter  and  explorer  he  finds  in  the  sci- 
entific enthusiast.  Exploring  beside  him  he 
begins  to  taste  not  only  the  familiar  flavor 
of  excitement  in  the  hunt,  but  the  stranger 
flavor  of  nature  itself, — the  tang  of  wildness, 
the  bitter-sweet  contrast  with  "  civilization." 
For  nature  is  as  wild  and  untamed  when 
we  meet  her  in  the  behaviour  of  the  human 
stomach  as  she  is  on  the  Amazon  or  at  the 
Poles.  There  is  a  characteristic  and  amazing 
difference  between  our  ways  and  hers, — that 
is,  between  what  man's  will  consciously 
makes  and  what  nature  makes  in  his  body 
outside  him. 

If  you  or  I  had  planned  the  human  brain 
we  should  have  made  both  halves  of  it  alike. 
But  Nature  has  planned  it  so  that  an  injury 
on  its  left  f oreward  end  abolishes  speech  while 
an  injury  to  the  corresponding  spot  on  the 
right  side  leaves  speech  intact.  A  human 
architect  after  arranging  for  two  lungs  and 
two  kidneys  would  certainly  have  provided 
two  livers  and  two  spleens.  Nature  prefers 
asymmetry  here, — one  liver  and  one  spleen 

23 


TRAINING  OF  THE  PHYSICIAN 

only.  Yet  not  asymmetry  everywhere.  The 
child's  hands  at  birth  are  extraordinarily 
alike.  Only  by  practice  he  becomes  "  right 
handed." 

The  undergraduate  looking  forward  to 
medical  study  and  seeking  to  prepare  for  it 
by  absorbing  the  scientific  spirit  will  find  (if 
he  looks  with  the  "  prehensile  eye  ")  that  the 
lover  of  nature's  secrets  is  deeply  versed  in 
the  contrasts  between  man's  and  nature's 
ways.  When  a  student  who  has  been  en- 
gaged in  a  piece  of  investigation  brings  his 
teacher  a  result  that  is  just  what  anyone 
might  have  expected — a  result  deeply  tinged 
with  man's  ways  of  thinking  or  manufactur- 
ing— the  teacher  at  once  suspects  slovenly 
work.  If  nature  is  represented  as  full  of 
right  angles  and  perfect  curves,  as  wholly 
verifying  our  first  hypothesis  and  matching 
someone's  thought  exactly — the  naturalist 
"  smells  a  rat."  He  knows  that  nature 
doesn't  behave  so,  that  her  lines  are  almost 
always  characteristically  irregular,  disap- 
pointing and  unpredictable. 

This  sort  of  instinct  for  the  irregularity  or 

24 


THE  PROFESSIONAL  TYPE  OF  DOCTOR 

"  wildness  "  of  nature  in  contrast  with  man's 
smooth  and  tame  ways,  is  one  of  the  "  scien- 
tific habits  of  mind  "  which  students  admire 
and  may  catch.  Because  we  can't  know  any- 
thing perfectly  until  we  know  the  whole  uni- 
verse which  circulates  through  it  like  blood, 
therefore  our  knowledge  about  any  natural 
object,  however  simple,  always  contains  a 
residuum  or  surd  that  is  stubbornly  unknown, 
though  never  unknowable.  This  residuum 
stands  for  all  the  future  discoverable  knowl- 
edge about  the  object.  The  stars  follow 
their  courses  pretty  nearly,  not  exactly.  The 
perturbations  which  make  our  figurings 
sometimes  or  somewhere  imperfect  represent 
all  we  don't  yet  know  about  the  matter  in 
hand. 

2.    AUSTERITY 

Recognizing  all  this,  the  scientific  student 
is  apt  to  present  certain  austere  or  iron  as- 
pects to  the  beginner.  Human  weakness, 
intellectual  rather  than  moral,  is  his  ancient 
enemy  and  he  is  armed  and  mailed  against  it. 
Intellectual  vices  such  as  the  tendency  to 
twist  our  results  to  suit  our  preconceptions 

25 


TRAINING  OF  THE  PHYSICIAN 

are  so  familiar  to  the  scientific  student  that  he 
has  steeled  himself  against  them.  Any  evi- 
dence of  impatience  or  of  intellectual  dishon- 
esty in  the  myriad  forms  of  "  softness  "  he  is 
prepared  to  repress.  Whoever  expects  quick 
results  that  have  value,  whoever  shows  the 
tendency  to  take  short  cuts  which  avoid  the 
necessarily  arduous  high  roads  of  science, 
faces  a  frowning  challenge  from  the  seasoned 
investigator. 

3.    KEEN     PREPAREDNESS     AGAINST     COMMON 
FALLACIES 

Another  mental  habit  which  the  student 
learns  by  contagion  from  good  teachers  is 
the  aptness  to  perceive  and  the  wariness  to 
avoid,  certain  ancient  and  tempting  fallacies, 
— classical  twists  of  reasoning  which  entrap 
almost  everyone  again  and  again  until  he 
has  learned  to  avoid  them.  The  commonest  is 
expressed  in  the  Latin  phrase  "Post  hoc, 
ergo  propter  hoc," — (after,  therefore  because 
of).  The  patient  takes  iron  and  recovers. 
Therefore,  we  fallaciously  suppose,  the  iron 
cured  him.  The  ball  team  acquires  a  mascot 

26 


THE  PROFESSIONAL  TYPE  OF  DOCTOR 

and  wins.  Therefore  (ball  players  say)  it 
wins  because  of  the  mascot's  presence !  One 
sits  in  a  draught  and  next  day  has  a  cold. 
Therefore  the  draught  caused  the  cold.  We 
had  prosperity  after  the  new  tariff  went  into 
operation.  Therefore  the  tariff  caused  the 
prosperity. 

Everywhere  this  form  of  stupidity  emerges 
to  lead  us  astray.  But  it  is  no  one's  business 
to  combat  it  more  frequently  than  the  scien- 
tific student.  He  fears  it  as  the  burnt  child 
fears  the  fire,  because  he  has  suffered  from  it. 

A  second  fallacy,  exemplified  daily  in  our 
medical  journals,  is  the  tendency  to  wide 
generalization  from  one  case  or  from  a  few 
cases.  "  All  men  are  cross  before  dinner," 
said  a  long  suffering  wife  of  my  acquaint- 
ance. No  wonder  she  thought  so,  for  her  hus- 
band and  her  grown-up  son  were  almost  the 
only  males  she  encountered  and  their  temp- 
ers were  certainly  not  sweetened  by  hunger. 
But,  until  it  was  pointed  out  to  her,  she  was 
quite  unaware  that  she  judged  all  mankind 
by  two  examples. 

By  similar  shortsightedness  we  ordinarily 

27 


TRAINING  OF  THE  PHYSICIAN 

argue  from  too  few  experiments  in  the  field 
called  scientific.  "  Typhoid  fever  will  get 
well  if  treated  with  drugs  which  kill  the  bacilli 
of  typhoid  in  the  intestine."  So  argued 
many  doctors  a  generation  ago.  They  had 
treated  a  few  cases  in  this  way  and  recovery 
had  followed.  But  if  they  had  continued  to 
treat  cases  in  this  way  until  one  thousand  or 
more  had  been  seen,  they  would  have  dis- 
covered that  some  groups  of  typhoid  cases 
are  mild  and  get  well  under  any  treatment 
or  no  treatment  at  all,  while  others  (not 
waited  for  when  the  cure  was  announced)  are 
so  severe  that  neither  this  drug  nor  any  treat- 
ment yet  known  can  prevent  death  in  10  per 
cent,  or  more  of  the  cases. 

We  argue  from  a  sample,  supposed  to  be 
a  fair  sample  of  all  the  rest.  But  often  it 
isn't, — as  in  typhoid  fever, — because  epidem- 
ics vary  in  severity. 

A  student  can  learn  this  sort  of  thing  in 
any  science  and  under  any  first-rate  teacher 
before  he  gets  to  medicine.  What  a  boon  to 
humanity  if  all  students  learnt  it  before  they 
began  to  "  practice  "  on  the  human  body! 

28 


THE   PROFESSIONAL  TYPE  OF  DOCTOR 
4.    SCIENTIFIC    IMAGINATION 

The  preparation  of  the  student  for  the 
type  of  medicine  in  which  investigation  will 
be  his  daily  work  should  include  contact  with 
teachers  who  know  not  only  how  to  avoid 
ancient  pitfalls  or  fallacies,  and  how  to  recog- 
nize the  contrast  between  nature's  ways  and 
our  ways,  but  also  how  to  speculate  or  how  to 
wonder. 

Speculation  and  verification  are  the  two 
essentials  of  scientific  progress.  Each  plays 
into  the  other's  hands ;  each  is  useless  without 
its  team  mate.  But  much  more  has  been 
written  and  said  about  the  experimental  or 
verifying  side  of  the  scientific  work  than 
about  its  speculative  side.  Hence  the  stud- 
ent's preparation  is  apt  to  be  neglected  just 
here.  Even  the  word  speculation  may  be 
unfamiliar  to  him  outside  of  stock  markets, 
real  estate  dealings  and  the  philosopher's 
chamber. 

But  in  its  generic  sense  the  capacity  to 
speculate  is  the  capacity  to  wonder  or  be  curi- 
ous about  something.  Millions  of  folks  had 

29 


TRAINING  OF  THE  PHYSICIAN 

seen  an  apple  fall  before  Newton  speculated 
on  the  event.  Most  of  us  are  so  used  to  the 
facts  around  us  that  we  rarely  wonder  about 
them  and  are  still  less  prone  to  wonder  if  a 
truth  can't  be  found  in  them.  We  endured 
our  short  winter  afternoons  for  centuries  be- 
fore it  occurred  to  anyone  to  wonder  if  a  city 
couldn't  vote  to  put  its  clocks  back  an  hour 
and  have  an  hour's  more  daylight  at  the  end 
of  the  working  day.  Of  course  the  hypo- 
thesis had  still  to  be  verified  and  in  my  city 
it  hasn't  yet  been  verified  as  it  has  in  Cleve- 
land and  elsewhere.  But  the  capacity  to 
wonder  was  what  made  it  possible  to  experi- 
ment and,  having  tried  longer  and  shorter 
daylight,  to  hold  fast  the  better. 

This  capacity  to  ff  wonder  if  "  means  crea- 
tive imagination,  the  rarest  and  most  valua- 
ble asset  of  a  useful  man.  It  is  hard  to  find 
and  harder  to  train.  The  capacity  to  wonder 
makes  it  possible  to  test  out  new  ideas  in  ex- 
periment. But  the  capacity  to  test  out  ideas 
by  experiment  doesn't  make  it  possible  to 
have  any  new  ideas  or  wonderings  of  value. 
Hundreds  of  men  can  test  out  an  idea  for 

30 


THE  PROFESSIONAL  TYPE  OF  DOCTOR 

every  one  man  who  can  invent  the  idea.  For 
that  is  what  it  comes  to.  The  power  to 
"  voonder  if "  is  the  power  to  invent ;  it  is 
originality. 

Presumably  one  can  increase  his  native 
stock  of  originality — large  or  small — by 
using  what  one  has,  as  one  strengthens  a  weak 
muscle  by  using  it.  Necessity,  of  course,  is 
the  most  fruitful  mother  of  invention  but 
necessity  is  hard  to  fake — hard  to  replace  by 
any  artificial  substitute.  Educational  sub- 
stitutes for  necessity  ( as  the  mother  of  inven- 
tion) are  just  what  educators  find  it  hardest 
to  invent, — because  there  is  no  necessity  that 
they  should!  Honors,  credit  marks  (and 
discredit  marks)  financial  rewards  or  losses 
are  the  stimuli  ordinarily  used  to  stimulate 
necessity.  But  they  are  poor  substitutes. 

Better  than  any  of  them,  probably,  is  close 
appreciative  contact  with  an  inventor.  By 
contagion  the  student's  embryonic  inventive 
capacities  may  perhaps  be  reached  and  in- 
flamed. But  this  sort  of  preparation  is  cer- 
tainly difficult  to  get.  It  means  prolonged 
intimacy  with  a  teacher  and  few  can  be  within 

31 


TRAINING  OF  THE  PHYSICIAN 

range  of  the  teacher, — close  enough  for  his 
emanations  to  hit  and  leave  a  mark.  The 
real  disciples  who  catch  the  master's  spirit 
must  always  be  a  few  per  master  and  the 
masters  themselves  are  hard  to  catch. 

Still,  I  believe  that  if  the  supreme  value  of 
the  capacity  for  speculation  was  realized, 
more  might  be  done  to  develop  it.  As  mat- 
ters are  now  the  showy  and  obvious  side  of 
scientific  work — the  laboratory  verification 
or  refutation  of  new  ideas,  the  technique  of 
finding  out  whether  they  are  true  or  not — is 
what  engages  attention  and  constitutes  the 
visible  and  tangible  work  that  the  public  calls 
"  scientific."  Yet  this  is  easy  to  do  and  easy 
to  buy  compared  to  that  rarest  of  all  capaci- 
ties— the  capacity  to  have  an  idea  worth  test- 
ing out.  Anybody  can  have  an  idea.  But 
few  of  them  are  worth  testing  out,  as  the 
theses  presented  yearly  for  Ph.  D.  degrees 
abundantly  testify.  These  essays  are  often 
"  original  work" — but  work  not  worth  doing. 

Stevenson  describes  his  own  creative  work 
in  terms  of  brooding  on  eggs.  To  have  an 
idea  is  good.  But  to  brood  on  it  long  is 

32 


THE  PROFESSIONAL  TYPE  OF  DOCTOR 

better.  Brooding  in  this  sense  means  keep- 
ing the  idea  "  in  the  back  of  one's  head  " — 
without  dropping  it,  yet  without  any  consci- 
ous attempt  to  work  it  out.  In  fashionable 
terminology  this  means  the  habit  of  "  using 
one's  subconsciousness  "  fruitfully.  But  here 
we  approach  a  region  little  explored.  How 
consciously  to  direct  our  subconsciousness  is 
an  art  of  which  little  is  known  and  less  still 
communicated.  Stevenson's  bread  and  but- 
ter depended  (he  thought)  on  this  art  of 
"brooding"  long  on  his  subject  before  he 
began  a  piece  of  writing.  Almost  everyone 
has  had  the  experience  of  thinking  hard  on 
a  matter,  laying  it  away  to  take  up  other  ac- 
tivities, and  then  returning  to  find  it  devel- 
oped amazingly  beyond  its  state  when  last 
envisaged.  Business  men  have  told  me  that 
their  best  ideas  for  new  business  are  apt  to 
come  into  their  heads  on  holidays  or  at  odd 
times  away  from  the  office.  "  I'll  sleep  on 
that  before  I  decide  "  indicates  a  similar  ex- 
pectation of  benefit  to  accrue  from  the  un- 
conscious activities  of  our  minds. 

How  then  can  students  preparing  for 

3  33 


TRAINING  OF  THE  PHYSICIAN 

medicine  be  trained  to  brood  ?  No  answer  has 
yet  been  given. 

Ostwald,  the  famous  physical-chemist,  and 
Tschaikowsky,  the  greatest  modern  Russian 
musician,  both  advocate  routine  work  as  the 
best  encouragement  of  invention.  Neither 
found  any  benefit  in  waiting  for  ideas  or  in 
any  deliberate  brooding  process.  Both  ad- 
vise us  to  work  away  daily  at  whatever  comes 
to  hand.  "  Whoever  works  hard  will  find 
something "  says  Ostwald.  Tschaikowsky 
forced  himself  to  write  something  in  the  way 
of  music  daily,  until  of  a  sudden,  inspiration 
would  seize  him  and  he  would  begin  to  have 
musical  ideas  worth  perpetuating. 

Whatever  technique  is  best,  the  state  of 
mind  out  of  which  this  side  of  scientific  ca- 
pacity comes  is  one  in  which  one  doesn't  see 
things  as  they  are  but  as  they  might  be.  It 
is  a  capacity  not  to  open  our  eyes  and  see  but 
to  shut  them  and  think,  or  with  open  eyes 
to  see  the  invisible, — the  possible  future  or 
perhaps  the  impossible, — as  verification  may 
later  decide.  In  a  generation  so  obsessed  as 
ours  with  the  visible  world,  so  smartly  aware 

34 


THE  PROFESSIONAL  TYPE  OF  DOCTOR 

of  the  present  and  so  dull  to  the  past  and 
future,  the  capacity  to  see  the  invisible  is  not 
easily  cultivated.  Creative  art  and  creative 
science  spring  from  the  same  root,  and  the 
aridity  of  our  artistic  fields  makes  it  im- 
probable that  great  scientific  creation  will 
come  at  the  present  time. 

Nevertheless  whoever  wishes  to  prepare 
himself  for  the  "  scientific  "  or  professional 
type  of  medical  work  certainly  should  try  to 
learn,  through  brooding,  through  intense 
labor,  or  through  contagion,  the  art  of 
speculation. 

5.    THE  USED  TOOLS 

Another  useful  part  of  the  student's  pre- 
paration, during  the  years  which  precede  the 
medical  school,  concerns  the  use  of  tools.  In 
biological  sciences  most  of  the  essential  tech- 
nique of  medical  research  is  employed.  Fa- 
miliarity with  the  use  of  the  microscope,  of 
the  smoked  drum,  of  charts  and  curves  re- 
cording accurate  measurements,  as  well  as 
some  acquaintance  with  the  uses  of  me- 
chanics and  electricity  in  research,  can  be 
acquired  in  pre-medical  studies.  This  is 

35 


TRAINING  OF  THE  PHYSICIAN 

even  more  obvious  in  the  case  of  chemical 
technique. 

French  and  German  are  tools  which  every 
prospective  medical  student  should  learn  to 
use  before  he  begins  medical  study,  for  ex- 
perience shows  that  he  seldom  learns  them 
later.  Most  medical  men  know  just  enough 
French  and  German  to  be  useless — just 
enough  to  make  them  "  side  step  "  when  the 
need  for  these  languages  appears  in  sight. 


36 


CHAPTER  II 

THE  TRAINING  OF  THE  FAMILY  PHYSICIAN 
1.  MEDICAL  SCHOOLS  AND  HOSPITALS 

THE  technical  side  of  a  general  practition- 
er's work  is  to  be  learned  in  the  medical 
schools  and  especially  in  his  period  of  hospi- 
tal interneship  intervening  between  medical 
school  and  the  beginning  of  practice.  Of  this 
period  the  only  thing  to  be  said  here  is  that 
the  students  should  be  content  only  with  the 
best  schools  and  the  best  hospitals.  Second 
and  third  best  will  not  do.  The  doctor  may 
be  handicapped  for  life  because  of  a  penny 
wise  pound  foolish  policy  in  this  matter.  He 
often  goes  to  the  nearest  medical  school  or  to 
the  cheapest  in  his  vicinity.  But  this  is  bad 
policy  for  anyone  who  is  not  too  poor  to  bor- 
row money.  Better  start  practice  with  a 
money  handicap  than  hampered  by  poor 
training.  The  former  can  be  made  up  for 
much  more  easily  than  the  latter. 

Good    medical  schools  are  those  which 
provide : 

37 


TRAINING  OF  THE  PHYSICIAN 

1.  Plenty  of  experience  with  patients  in 
hospitals. 

2.  Plenty  of  teachers  to  make  this  experi- 
ence intelligible. 

3.  Plenty  of  money  for  laboratories  and 
salaries. 

The  number  of  schools  which  provide  these 
three  essentials  within  the  borders  of  the 
United  States  is  not  large.  But  it  is  suffi- 
cient. Few  good  schools  are  as  yet  over 
crowded.  It  is  only  the  poor  schools  which 
are  over  crowded.  But  the  outlook  is  hope- 
ful for  the  number  of  medical  schools  of  low 
grade  has  diminished  rapidly  in  the  last  ten 
years  and  the  standards  of  those  remaining 
are  rising — because  they  must,  owing  to 
competition  for  students. 

To  get  into  one  of  these  schools  is  an  essen- 
tial of  good  preparation  for  the  American 
general  practitioner  or  specialist. 

2.    POST  GRADUATE  STUDY 

There  is  no  longer  any  need  to  go  abroad 
for  general  medical  improvement  after 
graduation.  American  post  graduate  in- 

38 


Faulty  prescription 

Practice  of  Pharmacy  (Remington). 

Types  of  prescription  writing. 


Odd  prescription 


<=7 


G/-  £*t£*+3f# 
<7 


Careful  prescription 
Practice  of  Pharmacy  (Remington). 


Badly  written  prescription 


Types  of  prescription  writing. 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

struction  has  now  caught  up  and  passed  that 
for  which  Americans  formerly  went  to  Ger- 
many, to  Paris  or  to  London.  For  special 
points,  of  course,  a  medical  virtuoso  may 
have  to  be  sought  out  in  one  or  another  Eu- 
ropean city ;  but  this  is  rarely  the  case  imme- 
diately after  graduation.  The  majority  of 
Americans  who  have  gone  to  Europe  in  re- 
cent years  for  general  medical  improvement 
have,  I  think,  wasted  their  time.  A  good 
many  have  told  me  so.  Later  on,  after  one 
has  been  in  practice  some  time  and  has  come 
through  reading  to  know  some  special  point 
on  which  the  personal  contact  with  a  particu- 
lar man  in  Europe  is  essential  ( and  attaina- 
ble) as  a  step  in  one's  growth — a  dash  across 
the  sea  for  a  few  weeks  is  sometimes  worth 
while.  But  no  more  of  the  months  and  years 
in  German  clinics.  Today  that  is  waste  sci- 
entifically and  sometimes  harmful  in  other 
ways.  To  witness,  without  protest,  such  in- 
human and  brutal  treatment  of  patients  as  is 
common  in  German  clinics  is  not,  I  believe, 
innocuous  to  post  graduates.  German  brut- 
ality and  callousness  is  as  notable  in  peace  as 

39 


TRAINING  OF  THE  PHYSICIAN 

it  is  in  war,  though  we  medical  men  have  said 
all  too  little  about  it  in  the  past. 

3.  THE  PSYCHICAL  ASPECT  OF  A  GENERAL 
PRACTITIONER'S  PREPARATION 

Thus  far  I  have  dealt  only  with  the  techni- 
cal side  of  the  practitioner's  training.  But 
many  practitioners  have  felt  keenly  in  later 
years  their  own  lacks  and  the  lacks  of  their 
training  on  the  non-technical  side.  The  an- 
swers to  a  questionaire  recently  sent  out  by 
Dr.  Arthur  B.  Emmons,  2nd,  director  of  the 
Appointments  Bureau  of  the  Harvard  Medi- 
cal School,  were  very  instructive  on  this  as 
on  many  other  points;1  132  of  317  who  an- 
swered the  questionaire  gave  specific  reply  to 
the  question :  '  What,  if  anything,  was  lack- 
ing in  your  Medical  School  course  to  fit  you 
for  your  particular  work?"  These  132  an- 
swers were  classified  in  the  following  way : 

1  The  Profession  of  Medicine.  A  collection  of 
letters  from  graduates  of  the  Harvard  Medical 
School,  edited  by  Dr.  Arthur  B.  Emmons,  2nd, 
Harvard  University  Press. 

40 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

LIST  OF  LACKS 

1.  Pharmacology     and     therapeutics     (i.e., 

drugs) ,. 58 

2.  Clinical  (i.e.,  bedside)  instruction 12 

3.  Business  training  .  ...,. , 11 

4.  More  practical  hospital  work 6 

5.  Surgery  (enough  for  general  practice)  ...  5 

6.  More  preliminary  education 5 

7.  The  art  of  the  practice  of  medicine 4 

8.  A  personal  advisor 5 

9.  Physical  examination  for  tuberculosis ....  1 

10.  An  appreciation  of  the  value  of  reading.  .  .  1 

11.  "  Teach  men  to  think  »>. ., 1 

12.  "Almost  everything" 1 

13.  "  Not  enough  of  little  things  " 1 

14.  Skin  diseases  (diagnosis)   1 

15.  Biacteriologyi  .  .(.,. ...... 1 

16.  Psychiatry 1 

171  Neurology    .  .  . 1 

18.  Tropical  diseases 1 

19.  Public  health  training 1 

20.  Clinics  on  skin,  eye,  ear,  etc 1 

21.  "  Too  little  money  " 1 

22.  "  Too  old  in  beginning  " ,.  .,.  1 

23.  Nothing  lacking  in  training 12 

132 
41 


TRAINING  OF  THE  PHYSICIAN 

LIST  or  LACKS 

In  this  list  items  6,  7,  8,  10  and  11  are  es- 
pecially suggestive  of  what  is  ordinarily  left 
out  of  medical  preparation — namely,  the 
preparedness  for  treating  a  human  being  as  if 
Tie  possessed  a  mind,  affections,  talents,  vices 
and  habits  good  and  bad,  as  well  as  more  or 
less  diseased  organs.  Admitting  that  it  is 
difficult  and  uncharted  ground  over  which  we 
must  go  when  we  try  to  teach  the  "  human 
side  of  the  medical  practice,"  yet  the  attempt 
should  at  least  be  made.  For  the  psychical 
side  of  practice  is  more  than  half  of  a  prac- 
titioners job  and  makes  or  mars  him, — makes 
him  by  honest  means  or  by  quackish  arts, 
mars  him  through  his  clumsiness  or  through 
his  onesided  concentration  on  the  physical 
aspects  of  disease. 

HUMAN  PSYCHOLOGY  NOT  NOW  TAUGHT  IN 
MEDICAL  SCHOOLS 

Men  intending  to  study  and  to  practice 
medicine  must  face  the  fact  that  medical 
schools  now  give  practically  no  attention  to 
the  psychical  side  of  the  doctor's  work.  Real- 

42 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

izing  this,  the  prospective  student  may  per- 
haps make  up  for  the  lacks  of  his  medical 
school  years  by  extra  attention  during  his 
premedical  years  to  the  subjects  which  he 
knows  will  be  neglected  by  his  medical  teach- 
ers. Instead  of  having,  (as  now)  to  "  pick 
up  "  knowledge  and  skill  in  such  matters  as 
best  he  can  during  the  hazardous  and  dis- 
tracted time  of  his  start  in  practice,  he  may 
perhaps  learn  something  of  the  art  of  human 
intercourse  before  he  enters  the  medical 
school. 

YET  IT  CAN  BE  LEARNED 

How  to  deal  with  people :  that  is  the  prob- 
lem. Many  a  man  never  learns  how  to  deal 
with  horses  and  knows  his  lack.  Horses  are 
skittish  or  "  wicked "  or  confused  when  a 
greenhorn  essays  them.  So  are  human  be- 
ings,— often  really  "  skittish,"  shy,  sullen, 
resentful,  prejudiced,  stubborn  or  "  wicked  " 
when  we  approach  them  clumsily.  Children 
especially  may  be  deemed  "  wicked  "  under 
these  conditions. 

Nevertheless,  as  people  can  learn  (if  they 
must)  a  good  deal  of  the  art  of  dealing  suc- 

43 


TRAINING  OF  THE  PHYSICIAN 

cessfully  with  horses  or  with  children,  so  it  is 
not  impossible  to  acquire  something  to  add  to 
our  native  stock  of  mother  wit  in  the  art  of 
human  intercourse  with  folks  in  general.  One 
need  not  leave  this  whole  field  to  instinct  and 
inherited  knack.  Witness  the  not  wholly  un- 
successful attempts  to  train  salesmen  and 
saleswomen.2  The  training  of  public  readers 
and  of  actors  is  not  altogether  unlike  the 
training  needed  by  salesmen  and  bears  some 
analogy  to  what  doctors  need.  How  to  get 
his  idea  or  his  feeling  across  to  the  public 
is  the  actor's  task.  He  can  learn  a  good  deal 
about  the  right  and  wrong  ways  of  touching 
or  reaching  an  audience,  feeling  its  pulse  and 
controlling  its  emotions.  The  doctor,  too, 
tries  to  touch,  to  reach,  to  control  his  patients 
and  must  learn  something  of  the  art  if  he 
can,  before  he  starts  in  practice.  The  sales- 
man learns  to  size  people  up,  to  understand 
their  more  aggressive  and  their  more  vulner- 
able sides,  to  recognize  the  ways  of  "  hand- 
ling "  different  types.  He  learns,  in  short, 

2  Classes  started  by  Mrs.  John  T.  Prince  at  the 
Boston  Women's  Educational  and  Industrial 
Union  in  1906. 

44 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

the  psychology  of  human  approach.  He 
learns  to  deal  with  men  in  one  way,  with 
women  in  another,  with  Irishmen,  Yankees, 
Southerners,  Jews,  Scotchmen,  each  in  a 
different  way. 

All  this  is  equally  necessary  in  the  edu- 
cation of  a  doctor.  But,  as  I  have  said,  he  is 
never  taught  it.  In  fact,  during  his  experi- 
ence as  a  hospital  interne  he  tends  to  forget 
whatever  he  had  previously  learned  as  to  the 
"  humanities,"  to  discard  whatever  he  had 
known  of  human  feelings,  fear,  delicacies,  as- 
pirations, and  especially  to  ignore  the  differ- 
ences of  individuals  and  their  need  of  indiv- 
idual treatment.  The  rush  and  routine  of 
hospital  work  tend  to  obscure  all  this,  and 
the  young  doctor  at  the  end  of  his  interneship 
is  often  more  nearly  dehumanized  than  at 
any  period  in  his  life — before  or  after  his 
hospital  year.  All  the  more  essential,  then, 
as  I  see  it,  that  he  should  learn  in  his  premedi- 
cal  days  all  that  he  can  of  the  art  of  success 
in  human  intercourse. 

This  art  is  to  be  learned  like  everything 
else,  by  practice  and  by  imitating  good 
models.  Anyone  can  practice  in  daily  life 

45 


TRAINING  OF  THE  PHYSICIAN 

the  two  complementary  parts  of  the  art — 
first  the  art  of  comprehending  another  per- 
son and  second,  the  art  of  making  one's  self 
understood.  Ordinarily  we  "  get  across  "  to 
others  only  a  fragment  of  our  ideas  and  a  still 
smaller  fragment  of  our  emotions.  Yet 
actors  and  salesmen  learn  to  communicate 
enthusiasm  as  well  as  fact.  They  marshal 
their  points  and  make  them. 

Of  course  the  first  essential  is  to  know  what 
we  want  to  convey.  Few  are  clear  about  this 
until  the  end  of  much  random  talk.  But 
our  heads  may  >be  cleared  without  noise. 
Thought  is  quicker  than  speech  and  it  is  more 
decent  as  well  as  more  effective  to  clarify  our 
muddy  brains  in  private  than  in  public. 

Then,  taking  another  leaf  from  the  sales- 
man's book,  one  may  select  one's  "talking 
points/'  Salesmen  know  that  among  the 
facts  which  they  might  adduce  in  the  effort 
to  win  a  customer,  there  are  some  more  at- 
tractive than  others — some  that  catch  atten- 
tion, enlist  sympathy  or  tickle  fancy.  Such 
are  good  "  talking  points  "  worth  memorizing 
and  using  again  and  again. 

46 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

Again  the  salesman  learns  by  experience 
that  it  never  pays  to  get  arguing  with  a  cus- 
tomer in  any  way  that  may  lead  to  antagonism 
of  attitude.  If  you  damn  the  article  that  a 
good  salesman  is  trying  to  sell  you,  he  will 
almost  always  agree  with  you,  if  he  can  see 
no  other  way  to  prevent  antagonism.  He 
tries  with  all  his  might  to  get  your  point  of 
view  and  to  agree  with  you  all  he  can. 

'  These  effervescent  waters  of  yours  are 
really  no  better  than  plain  water,"  I  said  the 
other  day  to  the  agent  of  some  "  Hot 
Springs."  ,  ((  Yes,  it  almost  seems  so/'  he 
answered  soothingly,  "  and  yet  we've  had 
wonderful  results  with  them,"  and  off  he 
slid  again  on  the  current  of  his  encomium. 

Of  course  the  honest  doctor  cannot  truckle 
and  yield  to  his  patients  as  a  salesman  some- 
times does  to  his  client,  but  he  will  imitate  the 
salesman  to  this  extent  at  any  rate — that  he 
will  avoid  antagonizing  his  patient  whenever 
this  is  possible  without  dishonorable  submis- 
sion. For  antagonism  is  an  atmosphere 
opaque  to  the  transfer  of  almost  all  mean- 
ings. One  can  neither  speak  through  it  nor 

47 


TRAINING  OF  THE  PHYSICIAN 

hear  through  it.  Yet  one  must  both  speak 
and  hear  effectively  if  one's  daily  medical 
tasks  are  to  be  accomplished. 

"  To  convince  another,  first  get  his  point. 
Then  move  the  point.  He  follows."  3  But 
in  a  mood  of  antagonism  one  can  neither  get 
nor  move  the  point.  Hence  doctors  often 
acquire  pacifist  tricks.  They  become  peace- 
at-any-price  men  in  relation  to  their  patients. 
Of  course  this  is  obviously  wrong.  There 
are  times  when  one  must  resist  a  patient's 
will.  He  wants  his  child's  scarlet  fever 
hushed  up,  not  placarded  in  red  on  the  house 
door  by  the  Board  of  Health.  He  may  be 
angry  enough  to  discharge  a  physician  who 
insists  on  doing  his  duty  in  protection  of 
the  public.  With  such  wrath  one  cannot 
make  peace  honorably.  But  it  is  amazing 
how  rarely  such  antagonisms  need  be  aroused 
if  the  doctor  has  himself  well  in  hand  and 
refuses  to  fight  without  good  reason.  A  doc- 
tor, like  a  nation,  can  learn  not  to  consider 
insult  a  cause  for  war.  Though  not  too  proud 

3  John  J.  Chapman  "  Causes  and  Consequences," 
p.  110  (Scribners,  1899). 

48 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

to  fight  for  the  public  good  and  the  rights  of 
civilization,  he  often  learns  that  to  resent  an 
insult  may  help  no  one.  Theoretically  the 
doctor  never  loses  his  temper  with  a  patient. 
That  would  be  unprofessional,  for  temper 
is  a  manifestation  of  broken  self-control  and 
professional  service  presupposes  self-control. 

Now  all  this  is  hard.  It  should  be  antici- 
pated and  practised  by  the  future  medical 
student  like  the  selection  of  "talking  points  " 
and  the  habit  of  wringing  the  water  and  the 
air  bubbles  out  of  one's  ideas  in  private  rather 
than  in  talk. 

Practice,  however,  is  only  half  of  this  edu- 
cation. It  is  inspired  by  watching  experts  and 
completed  by  imitating  them.  Many,  espe- 
cially many  women  and  many  Frenchmen, 
are  expert  in  the  long-practised  art  of  human 
intercourse.  One  can  sit  by  and  watch  a 
clever,  sympathetic  newspaper  reporter  "  get 
at  "  the  person  he  is  interviewing.  One  can 
admire  and  absorb  the  power  for  "  creative 
listening  "  possessed  by  many  good  women. 
Nor  need  one's  choice  of  masters  in  the  art 
be  confined  to  the  insignificant  fraction  of 

*  49 


TRAINING  OF  THE  PHYSICIAN 

humanity  which  is  now  alive  and  accessible 
to  us  in  the  flesh.  No  one  ever  understood 
people  nor  made  them  understand  him  as 
Jesus  Christ  did.  His  method  and  His 
spirit,  seen  best  in  His  own  words  and 
actions,  can  also  be  studied  in  those  of  His 
followers — in  St.  Paul,  in  St.  Francis  of 
Assisi,  in  Joan  of  Arc,  as  well  as  in  the  truest 
Christians  of  one's  own  acquaintance. 

Some  appreciation  of  this  sort  of  training 
as  an  essential  in  the  family  practitioner's 
training  is  suggested  in  Dr.  Emmons'  codi- 
fication of  Harvard  graduates'  opinions 
about  the  lacks  in  their  training.4  Three 
hundred  men  answered  the  question: 

"  In  pre-medical  education  do  you  favor 
a  predomination  of  ( 1 )  General  culture,  such 
as  History,  Philosophy,  Economics,  Litera- 
ture, and  Art?;  (2)  or,  Natural  Science,  as 
Physics,  Chemistry,  and  Biology?  " 

The  men  favoring  sciences  (the  present 
trend)  numbered  120,  and  those  favoring 
general  culture  110,  while  70  favored  both 
equally.  This  means  that  at  least  an  equal 

4  Loc.  cit.,  p.  11. 

50 


share  of  general  culture  with  science  in 
college  education  was  favored  by  180  out  of 
300  men.  Science  deals  largely  with  the 
non-human  world.  The  "  humanities,"  his- 
tory, economics,  philosophy,  and  literature 
deal  largely  with  the  thoughts  and  relations 
of  human  beings.  An  acquaintance  with  the 
"  humanities  "  in  this  sense  favors  the  de- 
velopment of  capacity  to  understand  and  to 
influence  our  fellows. 

Besides  the  art  of  appreciating  others' 
points  of  view  and  conveying  our  own,  the 
doctor  needs  to  know  all  he  can  of  the  Human 
Menagerie — the  types  and  varieties  such  as 
Balzac  hoped  exhaustively  to  map  out  in  his 
"  Comedie  Humaine."  When  a  doctor  is 
consulted  by  a  stock  broker  or  a  cattleman, 
a  laundress  or  an  actress,  he  needs  to  know 
all  that  he  can  about  what  fills  their  days  and 
their  thoughts — the  routine  detail  of  their 
lives,  what  they  take  for  granted,  what  they 
instinctively  like  and  dislike,  fear  or  admire. 
The  ways  and  habits  of  old  ladies,  young 
"  clubmen,"  candy-eating  girls — the  laxi- 
ties and  explosions  called  the  artistic  tem- 

51 


TRAINING  OF  THE  PHYSICIAN 

perament,  the  proportion  of  thick-headed- 
ness  usually  associated  with  "  hard-headed- 
ness  "  in  business  men.  For  these  are 
matters  which  may  form  the  basis  of  a 
correct  diagnosis  and  a  successful  course  of 
treatment. 

It  is  always  poor  policy  to  command  a  pa- 
tient to  do  what  one  knows  he  won't  or  can't 
do.  But  without  a  considerable  familiarity 
with  the  Human  Menagerie  one  does  not 
know  what  is  possible  in  the  way  of  absti- 
nence, reform,  or  comprehension  by  one  or 
another  type  of  person.  Women  are  sick 
oftener  than  men.  They  form  a  large  part 
of  any  doctor's  clientele.  Most  women  care 
for  religion.  Most  doctors  do  not.  Hence 
a  vast  deal  of  misunderstanding  and  misman- 
agement by  the  doctors  of  the  sex  prevailing 
in  medical  work. 

A  considerable  part  of  the  doctor's  task 
with  tired,  discouraged,  or  bewildered  pa- 
tients is  to  cheer  them  up.  But  with  most 
of  us  the  stock  of  cheering  words  and  acts 
is  very  limited.  Yet  the  art  of  encourage- 
ment is  one  capable  of  much  cultivation  and 
one  does  not  need  to  be  absolutely  original  in 

62 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

the  means  employed  with  each  sufferer.  For, 
as  the  reasons  for  discouragement  are  very 
similar  in  the  great  majority  of  people,  so  the 
remedies  may  be  similar  without  insult  or 
injustice.  Discouragement  results  from 
fatigue,  from  fear  of  the  future,  from  the 
sense  of  failure  (often  an  illusory  sense), 
from  recent  rebuke,  from  money  loss — but 
chiefly  because  to  the  mind  of  a  person  prone 
to  discouragement  1  +  1  +  1  —  10.  A  few 
successive  disappointing  words  or  mishaps, 
none  huge  in  itself,  seem  to  add  up  to  an 
overwhelming  total  of  hopelessness  because 
he  tends  to  take  them  as  samples  of  all  the 
rest  of  the  events  which  are  to  overtake  him 
in  the  remainder  of  life.  As  in  the  fallacy 
exemplified  on  page  26  we  argue  from  a  few 
facts  to  a  supposedly  universal  truth,  so  in 
discouraged  moods  we  allow  our  whole  out- 
look to  be  colored  by  the  tint  of  the  last  few 
days  or  hours. 

Realizing  this,  one  can  sometimes  remove 
a  patient's  "  blues  "  by  analyzing  them,  that 
is  by  eliciting  the  exact  history  of  the  par- 
ticular train  of  three  or  four  events  which 

53 


TRAINING  OF  THE  PHYSICIAN 

have  coalesced  in  his  distorted  vision  to  a 
lump  of  intolerable  misery.  When  he  comes 
to  enumerate  his  distressing  experiences,  sees 
how  few  they  are  and  how  groundless  his 
impression  that  the  whole  future  will  be  as 
bad,  he  can  often  throw  away  his  fears  and 
laugh  at  his  blues. 

"  Face  the  very  worst  that  can  happen," 
I  have  often  said  to  discouraged  patients, 
"  and  you  will  find  it  far  less  disastrous  than 
your  glimpsing  apprehensions  about  it. 
Turn  straight  towards  what  you  dread  as  we 
turn  a  horse's  head  towards  the  object  he  is 
shying  away  from,  and  you  will  find  it  can 
no  longer  scare  you."  For  example :  People 
are  often  a  prey  to  depression  and  inaction 
because  of  some  trifling  disease  in  which 
they  may  happen  occasionally  to  feel  faint- 
in  the  street  or  in  church.  "  Well,"  we  say 
to  such  a  sufferer,  "  face  the  worst.  Suppose 
you  did  faint  in  church.  It  wouldn't  do  you 
any  harm.  You  would  lie  down  for  a  while 
and  then  come  to  again.  Or  if  you  were  in 
the  street  you  might  have  to  sit  down  on  a 
doorstep  or  a  curbstone  for  a  bit.  Nothing 

54 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

very  awful  about  that.  But  what  is  more, 
if  you  get  so  that  you  don't  care  whether  you 
faint  or  not,  and  are  not  constantly  antici- 
pating it,  you  probably  won't  faint  at  all." 

I  have  written  out  these  details  to  show 
what  I  mean  by  the  psychical  preparedness 
of  the  doctor  as  it  should  be  and  rarely  is — 
the  trained  familiarity  with  the  moral  and 
emotional  difficulties  sure  to  be  encountered 
in  connection  with  illness  and  the  trained 
readiness  to  meet  them.  Not  that  anyone 
expects  to  solve  all  his  patient's  psychical 
puzzles  and  twists.  Often  the  most  experi- 
enced physician  fails  in  such  matters.  But 
"  the  readiness  is  all  ";  at  any  rate  one  need 
not  be  so  obviously  flabbergasted  as  to  dis- 
courage the  patient  still  further  by  the  spec- 
tacle of  our  discomfort. 

A  rich  and  cultivated  old  lady  was  once 
brought  to  me  by  her  son  because,  as  he  said, 
"  She  is  crying  herself  sick.  She  has  been 
grieving  her  very  life  out  for  a  year  over 
something  that  she  knows  can't  be  helped — 
my  father's  coldness  to  her  and  her  own  fear 
that  he  is  interested  in  some  other  woman. 

55 


TRAINING  OF  THE  PHYSICIAN 

She  knows  she  can't  do  anything  about  it  and 
that  crying  only  makes  her  worse;  but  she 
can't  seem  to  stop.  Lately  she  can't  sleep  or 
eat  and  we  are  getting  really  alarmed  about 
her." 

"  How  does  she  pass  her  time?  "  I  asked. 

"  She  just  mopes,"  he  answered,  "  she's 
given  up  all  her  old  interests." 

Obviously  the  first  thing  to  be  done  was  to 
discover  and  if  possible  revive  some  of  these 
abandoned  pursuits.  I  found  on  inquiry 
that  she  had  years  ago  painted  water-color 
copies  of  sea  shells  for  a  biological  museum 
and  that  she  had  been  at  one  time  so  expert 
in  this  that  her  work  was  in  great  demand. 
When  I  proposed  to  her  that  she  take  this 
up  again  she  wept  afresh.  "  No  one  wants 
my  painting  now,"  she  moaned,  "  and  I  have 
completely  lost  what  little  knack  I  once  had 
for  it." 

Now  it  is  a  familiar  fact  that  a  demand  for 
what  one  can  do,  a  real  need  for  it,  coming  to 
one  from  the  world  outside,  is  the  most  effec- 
tive stimulus  that  can  be  applied  to  an  en- 
nervated  interest.  Therefore  to  find  or 
create  such  a  demand  for  my  patient's  paint- 

56 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

ings  seemed  to  me  the  first  thing  to  try. 
After  some  inquiry  I  found  that  there  was 
still  a  need  for  shell-painting  and  that, 
through  the  efforts  of  her  son,  shell  speci- 
mens could  be  brought  to  her  house  so  that 
she  could  do  her  work  there.  The  museum 
director  was  easily  persuaded  to  write  her 
on  official  paper  a  business-like  letter  express- 
ing the  desire  of  his  board  to  enlarge  the 
museum  collection  of  colored  drawings  such 
as  he  knew  from  past  experience  that  she  could 
make.  This  letter  awakened  in  the  poor  lady 
the  first  gleam  of  genuine  pleasure  that  her 
family  had  seen  for  many  months.  Yet  she 
still  protested  that  she  could  not  do  it — had 
forgotten  it  all,  etc.,  etc.  Nevertheless  she 
was  easily  lured  into  talk  about  the  fascinat- 
ing, gossipy  details  of  water-color  technic, 
the  advantages  and  disadvantages  of  rough 
paper,  of  tinted  paper,  Japanese  rice 
paper,  sable  or  camel's  hair  brushes,  the 
choice  between  squeeze-tube  colors  and 
moist  color  in  pans.  Even  the  racy 
old  names  of  carmine,  crimson  lake,  rose 
madder,  burnt  sienna,  raw  umber,  Chinese 

57 


TRAINING  OF  THE  PHYSICIAN 

white,  cadmium  yellow  and  brown  ochre, 
made  her  brighten  up  as  she  rolled  them  on 
her  tongue  and  began  to  plan  for  a  color  box. 
Her  faded  interest  in  her  house  began  to  re- 
vive as  we  walked  about  its  innumerable 
rooms  choosing  one  where  she  could  get  the 
best  light  in  the  winter  months  at  hand. 

When  she  finally  got  to  work  she  was  sur- 
prised and  delighted  to  find  that  her  old  skill 
was  not  gone.  She  discarded  some  of  her 
first  attempts,  but  after  a  few  days  settled 
down  to  the  work  and  enjoyed  it.  Still  she 
had  lapses  especially  on  Sundays  when  she 
thought  it  wrong  to  work  and  when  her  hus- 
band's failings  were  more  than  usually  ob- 
vious. I  then  persuaded  her  to  keep  a  diary 
in  which  she  recorded,  not  her  feelings,  but 
her  actions,  including  the  number  of  times 
she  cried  each  week  and  the  duration  of  each 
cry.  This  diary  had  to  be  shown  me  at  her 
weekly  visits.  Before  long  the  irksomeness 
of  having  to  record  her  weeping  and  the  sor- 
did detail  of  its  bulk  and  frequency  began  to 
have  a  restraining  effect. 

"When  I  start  to  cry  and  then  remember 
that  I  shall  have  to  see  what  time  I  begin  and 

58 


TRAINING  OF  THE  FAMILY  PHYSICIAN 

what  time  it  is  when  I  stop  and  then  write 
it  down  and  show  it  to  you — I  sometimes 
burst  out  laughing  at  myself  and  don't  begin 

to  cry  after  all." 

******* 

The  psychology  that  one  needs  in  medical 
work  is  not  to  be  found  in  the  books  on  the 
subject.  One  picks  it  up  from  the  novels 
of  George  Meredith,  from  Conrad's  stories 
and  Tolstoi,  some  of  it  also  from  Emerson's 
essays  or  from  Shakespeare.  Eventually  I 
believe  it  will  be  written  out  in  systematic 
text-book  form ;  but  so  far  it  has  to  be  sought 
'in  all  sorts  of  books  and,  more  often  than  not, 
in  the  chance  treasures  of  conversation  or  in 

one's  own  memories. 

******* 

Though  patients  often  bring  problems  of 
metaphysics  or  of  religion  to  their  doctor  and 
agonize  about  free  will  or  immortality,  I 
doubt  if  a  student  could  profitably  study 
these  subjects  with  a  view  to  helping  his 
patients.  He  will  study  them  primarily  be- 
cause of  his  own  needs  if  he  is  the  sort  of  per- 
son who  is  likely  to  be  of  use  to  patients  thus 
puzzled. 

59 


CHAPTER  III 

PREPARATION  FOR  PUBLIC  HEALTH  WORK 

THE  health  officer  is  what  the  French  call 
an  "  entrepreneur," — much  more  nearly  an 
engineer  than  a  doctor  of  any  type  known 
hitherto  under  that  name.  He  faces  disease 
as  a  "  proposition,"  a  job  to  be  put  through 
and  finished.  The  classical  example  of  such 
a  job  was  the  work  of  General  Gorgas  and 
his  assistants  in  controlling  malaria  in  the 
Canal  Zone.  They  did  not  wait  for  sick 
workmen  to  call  at  the  doctor's  office,  but 
attacked  the  germ-pest  in  its  lair,  i.e.,  in  the 
marshy  jungles  along  the  track  of  the  canal. 
There  mosquitoes,  the  "  intermediary  hosts  " 
of  the  malarial  parasite,  multiply.  From 
them  the  parasite  is  conveyed  to  human  be- 
ings and  then  through  other  mosquito-bites 
from  person  to  person.  Gorgas  planned: 

(a)  To  diminish  the  number  of  mosqui- 
toes by  draining  and  clearing  the  land  where 
they  breed.  Without  abundant  stagnant 

60 


PUBLIC  HEALTH  WORK 

water  and  soggy  marshes  shaded  from  the 
sun  by  jungle,  the  mosquito  cannot  breed. 

(b)  To  diminish  the  number  of  malarial 
patients  accessible  to  mosquitoes  which  could 
carry  his  parasites  to  other  men.     This  was 
accomplished   by   careful    screening   of   all 
malaria-infected     workmen     during     their 
treatment  in  hospitals. 

(c)  To  kill  off  with  quinine  as  many  as 
possible   of  the   parasites   in  men   already 
infected. 

(d)  To  make  their  blood  poor  soil  for  the 
growth  of  any  parasite   which  mosquitoes 
might  introduce  during  the  men's  work  hours. 
This  was  done  by  having  all  workmen  take 
a  small  daily  dose  of  quinine. 

The  results  of  this  work  were  to  make  it 
possible  to  build  a  canal  where  the  French 
were  unsuccessful  because  of  mosquito- 
borne  malaria  and  mosquito-borne  yellow 
fever. 

This  great  engineering  feat  was  accom- 
plished as  much  by  the  medical  engineers  as 
by  the  steam  shovels  and  dredges.  It  has  re- 
mained ever  since  the  stock  illustration  and 

61 


TRAINING  OF  THE  PHYSICIAN 

effective  inspiration  of  all  who  hope  to  stamp 
out  disease  by  campaigns  directed  against 
its  source,  i.e.,  of  all  who  work  for  preven- 
tive medicine. 

THE  ENGINEER'S  STANDPOINT  ON  MEDICINE 
In  preparation  for  work  of  this  kind  the 
student  needs,  besides  his  technical  and  clini- 
cal training,  a  firm  grip  of  the  engineering 
habit  of  mind.  He  must  learn  to  think  of 
disease  in  wholesale  not  in  retail  terms. 
Above  all  he  must  dissociate  it  altogether 
from  the  idea  of  profit  or  of  getting  a  liveli- 
hood out  of  attendance  on  sick  people.  Since 
he  is  a  salaried  official  whose  success  is  in 
the  diminution  of  disease  and  therefore  of  the 
doctor's  profits,  he  must  become  accustomed 
to  the  constant  though  unspoken  opposition 
of  the  practising  physician.  He  will  find  that 
no  matter  how  useful  dispensaries  are  ac- 
knowledged to  be  in  the  campaign  for  public 
health,  cities  devoid  of  dispensaries  always 
have  trouble  in  starting  them  owing  to  the 
opposition  of  the  local  doctors.  He  must  be 
reconciled  from  his  outset  to  the  split  now 

62 


Considered  the  best  in  the  city,   with   one  exception.    (1911.)    Selling 
100  gallons  of  milk. 


PUBLIC  HEALTH  WORK 

opening  wider  and  wider  between  the  Health 
doctor  and  the  doctor  whose  work  is  sickness. 
On  the  other  hand,  the  Health  officer  finds 
himself  in  constantly  closer  alliance  with 
public  health  nurses,  with  social  workers,  and 
with  the  better  type  of  state  and  municipal 
officials  of  all  kinds.  For  health  is  a  common 
denominator  in  all  public  work ;  it  is  of  inter- 
est in  the  police  department,  and  the  street 
department,  in  the  schools  and  prisons  as  well 
as  in  the  domain  of  the  health  officer  himself. 
Every  one  needs  his  help  and  shares  his 
success. 

Familiarity  with  statistics,  with  charts, 
and  with  the  methods  of  surveying  or  map- 
ping out  any  problem  such  as  a  water  supply 
or  a  paving  system  is  of  value  in  the  prepara- 
tion of  a  health  officer.  For  he  must  sur- 
vey a  disease  as  a  whole,  trying  to  find  out, 
for  example,  how  large  a  problem  is  pre- 
sented by  the  total  tuberculous  infection  of 
Massachusetts — how  many  cases  and  how 
many  deaths  occur  each  year — how  this  total 
is  distributed,  whether  it  is  increasing  as  a 
whole  or  in  any  particular  localities,  whether 

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TRAINING  OF  THE  PHYSICIAN 

it  is  especially  common  in  any  trade  or  at  any 
age.  Then  he  computes  how  much  money  is 
needed  to  make  a  successful  attack  either  on 
the  whole  problem  or  on  some  manageable 
portion  of  it,  submits  his  estimates,  and  tries 
to  convince  the  legislative  committees  con- 
cerned. For  he  can  never  keep  out  of  politics, 
and  if  he  hates  politics  supremely  he  should 
seek  some  profession  other  than  that  of  health 
officer. 
******* 

The  preparation  of  consultants  and 
specialists  is  not  different  in  its  pre-medical 
and  scholastic  stages  from  that  of  general 
practitioners  although  in  the  end  the  two 
species  are  markedly  unlike.  The  consultant 
emerges  either  from  the  professional  or  from 
the  family  practitioner  type  of  doctor  and  the 
specialist  in  diseases  of  the  eye,  of  the  throat 
and  ear,  of  the  nervous  system,  etc.,  should 
by  rights  have  a  broad  training  in  medicine 
and  surgery  on  which  to  base  his  special  work. 
Only  in  this  way  can  the  eye  specialist  avoid 
treating  all  patients  as  if  they  possessed  eyes 
but  no  other  organs  or  senses. 

64 


Same  plant,   modern  and  sanitary  in  every  respect.    (1915.)     Selling  1000  gallons. 


PUBLIC  HEALTH  WORK 
GOOD  SPECIALISM  VS.   BAD   SPECIALISM 

A  few  words  may  be  in  order  here  on  the 
distinction  between  proper  and  improper 
specialties.  Diseases  of  the  eye  form  a  proper 
subject  for  special  practice  because  the  eye 
is  subject  to  many  maladies  almost  or  quite 
confined  to  that  organ  itself.  One  need  have 
only  a  good  working  knowledge  of  the  stom- 
ach, the  heart,  and  the  other  organs  in  order 
to  treat  diseases  of  the  eye  with  skill  and  com- 
petence. But  diseases  of  the  stomach  are 
not  a  proper  subject  for  a  specialty  because 
no  one  can  understand  the  patients  who  com- 
plain of  their  stomachs  without  knowing  a 
great  deal  about  many  other  organs.  Stom- 
ach complaints  are  often  due  to  diseases  of 
the  lungs,  of  the  brain,  or  of  the  kidneys, 
while  the  stomach  itself  is  perfectly  sound. 
Those  who  call  themselves  stomach  special- 
ists, if  they  are  expert  only  on  the  stomach 
must  be  bunglers.  While  if  they  are  well 
versed  in  the  usual  troubles  affecting  other 
organs  and  know  the  stomach  as  part  of  a 
chain  of  interdependent  members,  they  have 

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TRAINING  OF  THE  PHYSICIAN 

no  right  to  attract  patients  by  the  quite  un- 
candid  epithet  "  stomach  specialist "  which 
leads  the  public  mistakenly  to  suppose  that 
they  excel  general  practitioners  in  the  under- 
standing of  the  stomach — as  the  eye  specialist 
really  does  excel  him  in  knowledge  of  the  eye. 
The  same  strictures  apply  to  the  false 
specialty  "  gynaecology,"  or  diseases  of 
women.  To  know  women's  diseases  one  must 
know  far  more.  In  practice  the  gynaecolo- 
gist generally  includes  appendicitis  and  gall- 
bladder disease  in  his  province — though 
women  have,  of  course,  no  monopoly  of  these 
troubles. 


PART  II 

HELPS    AND    HINDRANCES    IN 
THE   DOCTOR'S    DEVELOPMENT 


CHAPTER  IV 

CONDITIONS  OF  FAILURE  IN  PRACTICE 

SUCCESS  and  failure  are  not  the  most  im- 
portant things  in  the  world.  Of  course  one 
wants  to  attain  success  and  avoid  failure. 
We  should  not  take  this  too  seriously.  To 
make  a  failure  in  the  first  field  one  attempts 
to  cultivate  may  be  one's  best  help  towards 
finding  a  better.  Only  by  such  hard  knocks 
are  we  capable  oftentimes  of  being  steered 
into  our  proper  path  in  life.  On  the  other 
hand,  failure  may  mean  that  the  world  is 
wrong,  not  we.  From  many  points  of 
view  Christ's  life  might  Have  been  called  a 
failure  and  many  a  composer  and  inventor 
has  failed  to  earn  his  living  or  to  impress  his 
generation. 

On  the  other  hand,  success  does  not  neces- 
sarily mean  ability,  far  less  virtue. 

Nevertheless,  no  one  wants  to  fail,  and  as 
I  said,  the  great  majority  of  failures  occur 
not  because  the  world  is  wrong  but  because 
of  some  quite  avoidable  blunder.  Such 


TRAINING  OF  THE  PHYSICIAN 

blunders   I   will  exemplify  from  my  own 
memory : 

1.  Many  men  fail  because  they  do  not 
keep  up  with  medical  progress.  Every 
young  man  thinks  when  he  graduates  and 
settles  down  to  practice  that  he  is  going  to 
devote  a  good  deal  of  time  to  reading.  But 
as  the  years  go  on,  he  devotes  less  and  less 
until  to-day  probably  the  medical  reading  of 
the  majority  of  the  physicians  in  this  coun- 
try consists  in  skimming  very  hurriedly  the 
titles  or  contents  of  one  medical  journal  a 
week.  Under  these  conditions  a  man  is  bound 
to  get  seriously  behindhand,  unless  he  is  for- 
tunate enough  to  meet,  in  his  hospital  work 
or  otherwise,  groups  of  fellow  practitioners 
who  will  enlighten  him  on  sides  of  medicine 
with  which  he  has  not  kept  abreast.  The 
chance  to  be  checked  up  in  this  way  is  one 
of  the  greatest  advantages  of  belonging  to  a 
hospital  staff.  Casual  phrases  let  fall  by 
other  members  of  the  staff  as  one  hears  them 
talking  in  a  ward  or  a  laboratory  may  awaken 
us  to  the  fact  that  we  do  not  even  know  the 
meaning  of  the  words  they  use  and  that  some- 

70 


CONDITIONS  OF  FAILURE  IN  PRACTICE 

thing  quite  familiar  to  them  is  a  blank  to  us. 
This  stimulates  further  inquiry,  perhaps  fur- 
ther reading.  The  natural  variations  of 
men's  interests  and  abilities  supplement  each 
other  and  stimulate  all  the  members  of  such 
a  group  as  I  have  just  referred  to.  Of  course 
if  none  of  these  men  did  any  reading  they 
would  not  stimulate  each  other  much.  But  a 
little  knowledge  may  leaven  a  sizable  lump 
through  the  mechanism  of  a  hospital  staff 
group. 

Next  to  the  neglect  of  reading  the  failure 
to  attend  district  medical  meetings,  state  or 
national  medical  meetings  is  probably  the 
commonest  cause  of  falling  behind  in  the 
march  of  medical  progress.  Such  meetings 
are  often  dull  and  almost  always  a  burden- 
some addition  to  the  day's  work,  yet  they  are 
indispensable,  especially  for  those  who  do  not 
have  hospital  connections. 

Still  more  stimulating  but  less  available 
for  all  are  visits  to  other  cities  and  contact 
with  the  ideas  and  practices  of  various  clinics 
and  teachers.  The  richer  and  more  ener- 
getic members  of  the  profession  are  in  the 

71 


TRAINING  OF  THE  PHYSICIAN 

habit  of  taking  each  year  at  least  one  trip  to 
some  centre  of  medical  progress,  not  ordi- 
narily to  attend  lectures  or  any  routine  teach- 
ing, but  to  look  about  and  pick  up  such  points 
as  can  be  happened  upon  in  a  casual  visit,  to 
make  rounds  in  a  hospital  ward  with  some 
well-known  practitioner  or  to  watch  his  work 
in  an  out-patient  clinic.  The  regular  mem- 
bers of  the  Mayo  Clinic  staff  are  required 
to  take  one  month  each  year  for  such  a  jour- 
ney of  education.  They  visit,  in  turn,  differ- 
ent clinics  in  this  and  other  countries,  and  on 
their  return  to  Rochester  report  to  the  rest 
of  the  staff  what  they  have  learned.  To  make 
such  a  form  of  mental  rejuvenation  not  only 
permissible  but  obligatory  is  a  most  enlight- 
ened policy. 

2.  Men  fail  now  and  then — but  much  less 
often  than  fifty  years  ago — by  reason  of  bad 
habits,  especially  alcoholism  and  morphinism. 

In  small  towns  patients  often  have  to  bear 
with  such  vices  on  the  part  of  their  physi- 
cians for  a  long  time;  but  sooner  or  later 
people  are  likely  to  rebel  or  the  competition 
of  better  controlled  colleagues  drives  the 

72 


CONDITIONS  OF  FAILURE  IN  PRACTICE 

drunkard  to  the  wall.  One  of  the  most  en- 
couraging things,  however,  about  the  medical 
profession  to-day  is  the  improvement  of  its 
habits  in  this  respect,  an  improvement  paral- 
lel to  that  which  is  notable  in  all  the  better 
educated  groups  of  the  American  people. 

Occasionally  I  have  known  a  man  fail  from 
sheer  laziness  and  neglect  of  his  patients; 
but  usually  such  laziness  has  been  connected 
with  some  disease  or  with  vicious  habits. 

3.  Now  and  then  a  man  fails  because  he 
becomes  known  as  an  abortionist.    In  some 
communities  this  practice  is  quite  compatible 
with  success;  but  medical  opinion  in  most 
places  is  so  strongly  against  it  as  a  means  of 
livelihood  that  the  regular  and  systematic 
abortionist  is  liable  to  fall  into  disrepute. 

4.  Twice  I  have  known  men  come  near  to 
failure  because  they  chose  the  wrong  place 
to  settle  in.     A  man  should  always  settle 
among  people  whose  ways  and  habits  he  likes, 
and  not  among  those  who  are  strange  and 
unattractive  to  him.    He  may  learn  to  adapt 
himself,  but  at  the  cost  of  great  labor  and 
pain.    One  of  the  best  trained,  most  faithful 

73 


TRAINING  OF  THE  PHYSICIAN 

and  most  skilful  practitioners  that  I  have 
known  came  near  to  failure  and  was  always 
near  the  danger  line  of  a  financial  crash  be- 
cause he,  a  typically  whole-souled  and  most 
refreshing  Southerner  by  temperament, 
chose  to  settle  in  an  old  New  England  com- 
munity whose  manners  he  did  not  under- 
stand. The  community  understood  him  just 
as  little  and  remained  for  years  unaware  that 
they  were  enjoying  extraordinary  good  for- 
tune in  having  a  man  with  such  ability  and 
character  settle  among  them.  This  man  is 
now  earning  his  living,  but  has  never  got  any- 
thing like  the  practice  and  popularity  which 
he  deserves,  merely,  so  far  as  I  can  see,  be- 
cause he  settled  in  the  wrong  place.  An- 
other man,  born  and  bred  in  New  England, 
has  made  an  excellent  living  in  a  western  state 
of  this  country  but  has  been  chronically  un- 
happy and  discouraged  because  he  does  not 
like  the  ways  and  customs  of  the  place  in 
which  he  elected  to  work.  To  be  perpetually 
annoyed  and  displeased  with  one's  surround- 
ings is  to  fail,  even  though  one  makes  a  good 
income. 

74 


CONDITIONS  OF  FAILURE  IN  PRACTICE 

With  this  and  other  examples  in  mind,  I 
have  always  counselled  medical  students  who 
are  looking  about  for  a  place  to  begin  prac- 
tice, that  they  should  choose  no  place  which 
seems  obviously  uncongenial  to  them  from  a 
social  point  of  view.  If  a  doctor  likes  the 
people  among  whom  he  is  to  practice,  they 
will  probably  like  him  and  seek  him.  If  he 
feels  shy,  constrained  or  bored  in  their  pres- 
ence, the  experience  will  probably  be  a 
mutual  one  and  he  will  suffer  by  comparison 
with  others  who  feel  more  at  home. 

5.  Occasionally  a  man  gets  into  medicine 
who  doesn't  really  like  the  job.  Such  a  one 
warned  me  very  seriously  when  he  heard  that 
I  was  thinking  of  studying  medicine. 
"What  on  earth  do  you  do  that  for?"  he 
said.  "  It  is  a  dog's  life.  No  holidays,  no 
Sundays,  no  evenings,  nothing  but  a  steady 
grind  and  mighty  little  thanks  for  it !  Medi- 
cal school  and  hospital  service  is  good  fun, 
to  be  sure,  but  after  that  it  is  an  awful  anti- 
climax." I  have  always  been  glad  that  I  did 
not  feel  alarmed  at  this  low-spirited  advice, 
although  it  was  given  by  a  very  sagacious 

75 


TRAINING  OF  THE  PHYSICIAN 

physician  of  large  practice.  Very  obviously 
the  whole  thing  was  against  the  grain  with 
him  and  I  regard  it  as  failure  when  a  man  has 
to  drive  himself  on  from  a  pure  sense  of  duty 
in  any  profession  which  he  chooses. 

6.  Although  men  of  very  various  tempera- 
ments and  characteristics  have  been  happy 
and  successful  in  medical  practice,  there  are 
certain  traits  which  go  far  I  think  to  dis- 
qualify a  man  or  at  any  rate  to  make  his 
life's  journey  a  steady  up-hill  drudgery. 
One  of  these  is  indecision.  Some  most  ex- 
emplary and  useful  citizens  are  compelled  by 
their  nature  or  by  their  training  to  make  all 
decisions  slowly  and  with  difficulty.  Doubt- 
less such  persons  can  be  happy  and  efficient 
in  other  callings;  but  it  is  almost  impossible 
that  they  should  get  along  smoothly  in 
medicine.  For  in  that  profession  decisions 
must  very  often  be  abrupt  and  irreversible. 
Anyone  who  finds  such  decisions  difficult  and 
burdensome  will  be  unhappy  in  medical 
practice. 

Others  who  are  not  really  indecisive  have 
not  the  capacity  or  the  physique  for  leader- 

76 


CONDITIONS  OF  FAILURE  IN  PRACTICE 

ship.  They  do  not  convince  patients  of  their 
clear-headedness  and  decision.  They  seem 
to  patients  to  be  following  rather  than  lead- 
ing, to  be  bored  rather  than  eager,  impassive 
rather  than  energetic.  Patients  almost  al- 
ways want  clear  leadership.  They  do  not 
blame  the  man  who  doesn't  give  it — they 
simply  go  elsewhere.  By  great  faithfulness 
and  devotion  a  man  may  make  up  for  the 
lack  of  decisiveness,  but  his  success  and  satis- 
faction are  likely  to  be  very  limited. 

7.  The  majority  of  physicians  in  this  coun- 
try get  very  poor  training  yet  many  of  them 
are  saved  from  the  failure  which  this  would 
naturally  imply  because,  through  their  own 
native  ability,  they  make  good,  after  entering 
practice,  the  most  important  lacks  in  their 
education.  This  is  hard  on  patients,  for  it 
means  that  we  have  to  learn  on  them  what 
should  have  come  to  us  through  our  medical 
school  studies,  and  though,  as  I  have  said, 
most  men  do  struggle  out  of  the  difficulties 
created  for  them  by  the  defects  of  their  train- 
ing, now  and  then  a  man  is  unable  to  pick  up 

77 


TRAINING  OF  THE  PHYSICIAN 

by  the  way  the  fundamental  knowledge  which 
he  was  supposed  to  have  at  the  beginning. 

8.  Finally,  I  have  known  a  few  men  fail 
because  they  could  not  get  on  with  their  fel- 
low practitioners  and  were  always  in  hot 
water  over  some  trifle.  Such  a  man  has  to 
be  absolute  monarch  of  all  he  surveys;  else 
he  is  always  in  trouble.  If  he  happens  to 
settle  in  a  place  where  there  are  other  would- 
be-absolute  monarchs  in  the  medical  field,  his 
path  is  a  thorny  one. 


78 


CHAPTER  V 

FACTORS  OF  SUCCESS 

1.  Naturally,  I  hold  that  a  man  succeeds 
by  the  virtue  of  the  opposites  corresponding 
to  all  the  defects  I  have  just  named.  He 
gains  his  ends  by  reason  of  good  training, 
good  habits,  fitting  temperament,  right  choice 
of  his  field  of  practice,  and  so  forth.  But 
I  think  it  is  worth  while  to  mention  certain 
reasons  for  success  which  happen  to  have 
been  exemplified  within  my  knowledge. 

I  remember  once  asking  an  old  practi- 
tioner, just  before  I  entered  practice,  how 
anyone  ever  got  any  patients.  His  answer 
has  been  very  widely  verified  in  what  I  have 
seen  of  medical  success.  He  said:  "  One  gets 
more  patients  by  being  faithful  to  the  few 
one  has."  If  you  show  real  devotion,  people 
pass  the  word  along  to  others  and  you  get 
known  and  sought  after.  This  is  a  physi- 
cian's best  as  well  as  his  most  graceful  method 
of  advertising.  People  notice  a  great  deal 

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TRAINING  OF  THE  PHYSICIAN 

more  than  we  think.  I  can  remember  my 
mother's  comment  after  the  first  visit  of  a 
new  doctor  whom  she  had  just  called  in  on 
recommendation  of  an  elder  practitioner  who 
had  been  our  family  physician  but  was  now 
retiring  from  active  work.  "  Dr.  S.  ex- 
amined the  baby  all  over,"  she  said,  "  al- 
though he  had  nothing  the  matter  with  him 
except  a  cold."  This  rightly  impressed  her 
as  a  sign  of  thoroughness  and  care  on  the 
doctor's  part  and  gave  her  confidence  that  his 
decision  was  correct.  Having  shown  faith- 
fulness in  a  slight  case,  she  was  ready  to  trust 
him  when  more  serious  matters  turned  up. 

2.  More  disquieting  is  the  success  of  those 
who  acquire  a  large  practice  because  of  blar- 
ney and  a  "  gift  of  the  gab."  I  have  often 
seen  men  grossly  ignorant  of  the  technique  of 
medicine  and  quite  unconscientious  in  their 
study  of  their  patient's  diseases,  acquire  a 
wide  popularity  and  a  large  income  because 
of  their  power  to  please,  to  flatter  and  to 
cajole  their  patients.  Every  physician  has 
abundant  need  of  all  the  social  skill  that  he 
can  acquire  and  honestly  apply.  The  suavi- 

80 


FACTORS  OF  SUCCESS 

ter  in  modo  is  fully  as  important  as  the  fort- 
iter  in  re.  We  are  responsible  for  "  getting 
it  across  "  as  well  as  for  good  intentions  and 
clear  ideas.  But  it  must  be  confessed  that 
social  skill  is  often  an  accomplishment  suffi- 
cient to  make  up  for  any  degree  of  medical 
incompetence  on  the  technical  side  of  the  pro- 
fession. I  like  to  believe  that  there  is  less 
room  for  this  type  of  chicanery  than  there  was 
twenty-five  years  ago  and  that  the  available 
space  is  constantly  dwindling  as  people  get 
more  general  knowledge  of  the  body  in  health 
and  disease  and  of  the  methods  necessary 
for  a  correct  diagnosis  and  sensible  treatment. 
The  more  people  see  of  the  medical  work 
done  at  hospitals  and  in  connection  with 
universities,  the  less  they  are  likely  to  be 
fooled  by  a  smooth  tongue  as  a  substitute 
for  thorough  medical  study  and  construc- 
tive therapeutics. 

3.  A  relatively  small  number  of  men  ac- 
quire an  important  vogue  and  a  permanent 
place  in  the  community  because  they  get  hold 
of  a  new  idea  or  transplant  one  to  a  new 
locality.  The  man  who  is  the  first  to  use 

81 


TRAINING  OF  THE  PHYSICIAN 

X-ray  diagnosis  in  any  given  locality  is  likely 
to  maintain  the  lead  over  his  fellow  practi- 
tioners. Similar  leads  are  obtained  and  then 
lost  in  case  one  exploits  an  idea  which  is  new 
but  not  true.  This  has  been  the  case  with 
most  of  those  who  have  made  a  specialty  of 
vaccines  and  vaccine  treatments  following 
the  supposed  discoveries  of  Sir  Almoth 
Wright.  Such  reputations  go  up  with  the 
rocket  and  come  down  with  the  stick.  The 
new  and  true  idea  may  be  a  plan  of  organiza- 
tion, as  in  the  case  of  the  Mayo  Clinic,  or  a 
wise  choice  of  a  specialty;  not  recognized 
before  and  not  intensively  cultivated  by  those 
with  whom  the  individual  must  compete.  The 
field  of  brain  surgery  is  an  example  of  what 
I  mean. 

4.  Finally,  a  man  may  succeed  by  sheer 
natural  ability  without  any  special  origi- 
nality, without  any  unusual  skill  in  pleasing 
people  or  any  unusual  devotion  to  unpleasant 
tasks.  This  type  of  ability  is  usually  a 
capacity  for  falling  on  one's  feet,  no  matter 
how  often  or  how  rudely  upset,  the  capacity 
to  meet  new  situations — in  a  word,  re- 

82 


FACTORS  OF  SUCCESS 

sourcef  ulness.  It  is  the  possession  of  the  rela- 
tively large  amount  of  this  sort  of  capacity 
that  makes  Occidental  nations  thus  far  better 
practitioners  than  Oriental,  who  are  more 
prone  to  be  non-plussed  in  a  new  situation  or 
to  lose  nerve  when  confronted  with  an  emer- 
gency. From  this  point  of  view  I  would  back 
the  American  doctor  against  the  representa- 
tive of  any  other  nation. 


83 


CHAPTER  VI 

THE  CHANCE  FOR  THE  YOUNG  DOCTOR 

A  GENERATION  ago  it  was  almost  essential 
for  the  young  doctor  to  grow  a  beard,  and  I 
can  remember  the  strenuous  efforts  of  my 
classmates  in  this  direction  during  the  con- 
cluding years  of  our  medical  education.  To- 
day such  devices  are  unnecessary.  The 
young  get  really  too  good  a  chance  in  compe- 
tition with  those  of  maturer  experience.  The 
public  is  nervously  alert  in  relation  to  the 
necessity  of  consulting  an  up-to-date  man, 
abnormally  apprehensive  about  the  evils  of 
being  behind  the  times.  Unless  a  young 
physician  is  really  childish,  he  has  nothing  to 
fear  from  the  scantiness  of  his  years — at 
any  rate  in  this  country,  and  at  the  present 
time.  Youth  is  at  a  premium  and  exerts,  I 
think,  even  more  than  its  normal  claim  upon 
our  recognition  and  respect.  The  public  is 
clearly  aware,  in  fact,  too  clearly  aware  that 
the  young  man  has  generally  been  better 
educated  medically  than  the  older  practi- 

84 


CHANCE  FOR  THE  YOUNG  DOCTOR 

tioner.  Great  and  revolutionary  discoveries 
have  recently  been  made  (so  the  public 
thinks)  in  all  directions,  but  especially  in  the 
field  of  medicine.  The  young  man  is  sup- 
posed to  be  fully  cognizant  of  these ;  the  older 
man  is  assumed  to  be  ignorant  of  them. 

It  hardly  needs  to  be  said  that  this  view 
of  the  matter  is  radically  incorrect.  The 
young  man  may  know  a  great  many  things, 
including  a  large  number  that  are  not  so. 
He  may  altogether  neglect  methods  of  diag- 
nosis or  of  treatment  which  happen  just  now 
to  be  out  of  fashion,  for  fashion  is  alarmingly 
powerful  in  medicine  as  well  as  everywhere 
else. 

Nevertheless  the  young  man  should  make 
all  that  he  legitimately  can  out  of  this  as- 
tounding readiness  on  the  part  of  the  public 
to  believe  that  youth  is  no  disadvantage. 
Since  people  are  expecting  him  to  be  up-to- 
date,  it  is  incumbent  upon  him  to  meet  the 
expectation  and  to  deserve  success  by  keep- 
ing abreast  with  all  that  is  solid  in  the  chang- 
ing surface  of  medicine,  while  estimating  fads 
and  fashions  at  their  true  value. 

85 


TRAINING  OF  THE  PHYSICIAN 

The  genuine  superiority  of  the  older  man, 
when  it  exists,  may  be  due  perhaps  to  the 
fact  that  he  has  had  an  opportunity  to  do  a 
given  operation  more  times  than  his  younger 
colleague  and  has  profited  by  the  worth  of 
his  experience,  learning  something  out  of 
each  case.  The  same  thing  holds  true  in  diag- 
nosis. An  older  man,  if  he  has  kept  his  eyes 
open  and  given  himself  a  chance  to  think, 
has  been  able  to  develop  his  powers  of  diag- 
nosis through  the  experience  of  the  varieties 
which  any  particular  disease,  such  as  pneu- 
monia or  appendicitis  may  present  and  even 
render  familiar  to  us  when  we  have  had  time 
to  encounter  many  cases.  He  is  less  likely  to 
be  fooled  by  superficial  resemblances  between 
one  disease  and  another;  less  likely,  also,  to 
be  thrown  off  the  scent  by  the  peculiar  varia- 
tions which  every  disease  exhibits  in  the 
bodies  of  different  individuals.  For  indi- 
viduality shows  itself  in  the  way  people  take 
their  diseases  when  they  are  sick,  as  well  as 
the  way  they  behave  when  healthy. 

On  the  other  hand,  a  man  may  have  had 
an  enormous  experience  of  disease  in  the 

86 


CHANCE  FOR  THE  YOUNG  DOCTOR 

sense  that  large  numbers  of  cases  have  passed 
through  his  hands,  and  yet  he  may  not  have 
been  alert  enough  or  given  time  enough  to 
get  any  experience  or  wisdom  out  of  them. 
He  may  continue  to  see  only  what  he  has  seen 
before,  remaining  blind  to  the  unexpected  and 
the  new.  This  is  true  of  us  all  to  a  most 
disquieting  extent.  Alcoholic  paralysis  of 
the  legs,  lasting  for  weeks  after  alcoholic  ex- 
cess, must  have  been  seen  by  physicians  again 
and  again,  ever  since  the  days  of  Noah.  Yet 
it  was  never  recognized  until  the  middle  of 
the  nineteeth  century.  So  it  is  with  the 
connection  between  joint  disease  and  tonsil- 
itis,  which  to-day  seems  so  obvious  that  we 
can  hardly  believe  that  there  is  anything  new 
about  it,  yet  which  we  wholly  overlooked 
until  within  fifteen  years.  The  capacity  for 
blindness  to  what  is  right  under  our  noses  is 
so  deep  and  human  a  quality  that  we  are  not 
always  certain  of  wisdom  increasing  with  the 
advance  of  years.  In  some  ways  a  greenhorn 
is  more  likely  to  see  a  new  truth  than  one 
who  has  passed  other  truths  by  unnoticed  for 
many  years. 

87 


TRAINING  OF  THE  PHYSICIAN 

As  a  rule  the  older  practitioner  is  dis- 
tinctly more  competent  than  the  younger  on 
the  mental  and  spiritual  side  of  disease.  The 
elderly  doctor  may  be  incompetent  in  this 
field  but  the  young  doctor  is  almost  sure  to 
be  incompetent,  for  his  very  training  and 
scientific  habit  of  mind,  his  very  familiarity 
with  all  that  is  up-to-date,  everything,  in 
short,  that  gives  the  young  man  his  genuine 
points  of  superiority  to  the  older,  tends  to 
make  him  blind  to  the  mental  and  spiritual 
life  of  sick  people.  His  attention  has  been 
turned  so  strongly  in  another  direction  that 
it  would  be  almost  unnatural  if  he  took  due 
recognizance  of  those  sides  of  his  medical 
work  which  depend  upon  a  full  recognition 
of  the  patient's  character  and  states  of  mind. 

Another  insuperable  advantage  possessed 
by  the  physician  who  has  practised  medicine 
for  a  long  time  in  one  city  is  that  he  may  have 
a  chance  to  see  that  a  given  organ,  say  the 
heart,  is  to-day  in  precisely  the  same  condi- 
tion as  it  was  five  or  ten  years  ago  when  he 
studied  and  recorded  its  condition.  This 
knowledge,  which  is  of  the  greatest  value  in 

88 


CHANCE  FOR  THE  YOUNG  DOCTOR 

predicting  the  outcome  and  understanding 
the  present  nature  of  the  case,  cannot  possibly 
be  possessed  by  one  who  has  but  recently 
begun  practice.  I  examined  recently  the 
heart  of  a  young  man  desirous  of  enlisting 
in  the  army.  His  heart  showed  an  unusual 
sound — what  is  known  as  a  "  murmur,"  which 
would  probably  be  sufficient  to  cause  his  re- 
jection if  he  were  examined  by  anyone  who 
had  never  seen  him  before.  But  as  I  had  had 
the  opportunity  of  listening  to  his  heart  from 
time  to  time  over  a  period  of  thirteen  years 
and  knew  that  this  "  murmur  "  had  remained 
entirely  unchanged  during  the  whole  of  that 
period,  while  no  other  evidence  of  heart  dis- 
ease developed,  I  was  able  to  write  a  letter 
which  will,  I  believe,  make  it  possible  for  him 
to  pass  his  medical  examinations  and  to 
enlist. 

A  mature  practitioner's  knowledge  of 
family  characteristics  gives  him  further  an 
undeniable  advantage  in  competition  with  a 
younger  man.  Knowing  the  parents  and  the 
other  brothers  and  sisters  in  a  family,  through 
having  attended  their  illnesses  over  a  long 

89 


TRAINING  OF  THE  PHYSICIAN 

period  of  time,  he  ought  to  be  able  to  inter- 
pret a  puzzling  or  peculiar  symptom  in  a 
younger  member  of  that  family  better  than 
any  greenhorn  could. 

Still  another  advantage  possessed  by  the 
doctor  who  has  practised  for  many  years  in  a 
single  community  and  gained  the  entire  con- 
fidence of  certain  people,  is  his  capacity  to 
work  therapeutic  miracles  by  reason  of  the 
"  expectant  attention,"  the  apostolic  faith 
of  those  who  have  come  to  put  their  trust  in 
him.  The  capacity  to  work  miraculous  cures 
is  generally  understood  now-a-days  to  rest 
upon  the  extraordinary  faith  or  expectation 
on  the  part  of  the  patient.  Such  a  faith  takes 
time  to  build  up  and  a  doctor  fresh  from  the 
medical  school  can  no  more  expect  to  possess 
it  or  to  make  use  of  it  than  he  can  share  the 
memories  of  the  oldest  living  inhabitant. 


90 


CHAPTER  VII 

CITY  PRACTICE  vs.  COUNTRY  PRACTICE 

IN  country  practice,  or  in  work  done  in  a 
small  town,  the  necessity  of  standing  on  one's 
own  feet  and  doing  almost  every  kind  of 
medical  and  surgical  work  after  a  fashion 
and  without  help  from  those  skilled  in  par- 
ticular branches  of  work,  tends  to  develop 
self-reliance  and  resourcefulness  of  a  high 
grade.  A  man  wholly  lacking  in  these  quali- 
ties can  sometimes  make  a  living  in  a  city, 
but  almost  never  in  the  country.  It  is  cer- 
tainly true  that  men  of  low  grade  of  ability 
can  get  along  somehow  in  the  city.  They  are 
men  who  would  be  driven  out  of  practice  alto- 
gether if  they  tried  to  work  in  the  country. 

Country  practice  has  an  undeniable  claim 
on  those  whose  natural  instincts  and  affec- 
tions draw  them  to  the  country  rather  than 
to  the  city,  for  as  I  have  already  said,  a  man 
is  most  likely  to  succeed  where  he  is  happy  and 
if  his  taste  for  country  life  is  old  and  strong 
he  will  have  to  work  against  a  great  obstacle 
in  case  he  settles  in  a  city. 

91 


TRAINING  OF  THE  PHYSICIAN 

At  the  present  time  the  great  majority  of 
physicians  would  prefer,  I  think,  to  work  in 
large  cities  if  they  could  be  sure  of  succeed- 
ing there.  The  difficulties  of  getting  started 
are  probably  what  deter  many  men  from  city 
practice.  The  larger  income  open  as  a  possi- 
bility in  city  practice  and  the  advantages  in 
education,  recreation  and  the  like,  weigh  very 
strongly  with  most  of  the  men  whom  I  have 
known.  Yet  anyone  who  settles  in  the  city 
to-day  must  give  up  once  for  all  the  ideal  of 
becoming  the  family  practitioner,  the  pa- 
tient's guide,  counsellor  and  friend — the  type 
described  in  "  Beside  the  Bonnie  Brier 
Bush  "  and  other  stories.  In  many  ways  this 
is  a  great  loss.  But  I  do  not  think  it  is  pos- 
sible to  do  satisfactory  work  in  this  sort  of 
practice  in  the  city.  In  the  country  where 
specialists  are  not  available,  one  is  perfectly 
right  in  taking  all  kinds  of  practice  and  be- 
coming the  single  arbiter  of  all  the  medical 
fates  which  confront  a  family  over  long 
periods  of  years.  Accepting  such  a  responsi- 
bility one  grows  into  very  close  human  rela- 
tionships with  a  family,  relations  often  lasting 

92 


CITY  VS.  COUNTRY  PRACTICE 

more  than  one  generation.  Since  the  sort  of 
friendships  thus  formed  are  among  the  very 
best  things  in  life,  anyone  who  gives  up  coun- 
try practice  must  realize  that  he  is  foregoing 
his  chance  for  one  of  the  greatest  prizes  that 
the  medical  profession  can  offer.  He  must 
also  realize,  as  I  have  said  above,  that  his  own 
personal  development  and  character  will 
probably  be  ampler  in  country  practice  than 
in  city  practice. 

Against  these  powerful  advantages  he 
must  balance  the  disquieting  fact  that  in 
country  practice  a  conscientious  man  is  often 
aware  that  his  patients  are  not  getting  the 
benefit  of  the  best  medical  knowledge  and 
skill  thus  far  developed.  He  must  realize 
that  his  diagnoses  are  often  wrong,  more 
often,  that  is,  than  would  be  necessary  in  city 
practice  and  that  his  treatments,  conse- 
quently, are  often  at  fault. 

If  he  is  skeptical  as  to  the  part  played  by 
medicine  and  surgery  in  the  cure  of  disease 
and  thinks  that  nature  does  most  of  the  work 
anyway,  his  own  limitations  will  not  trouble 
him  much.  Otherwise,  they  may  be  a  con- 
siderable source  of  worry  to  him. 

93 


TRAINING  OF  THE  PHYSICIAN 

In  city  practice  a  conscientious  man  can 
obtain  the  help  of  others  who  are  skilled  in 
the  branches  of  medicine  where  he  himself 
is  deficient.  If  he  cannot  give  his  patient 
the  best,  he  can  get  the  best  for  him — at  any 
rate,  in  many  cases  and  when  hospital  facili- 
ties are  fairly  adequate  in  the  city  where  he 
has  settled.  Yet  the  division  of  responsibility 
between  different  physicians  often  has  its 
drawbacks  for  the  patient  as  well  as  for  the 
physician  himself  who  becomes  narrower  than 
he  needs  to  be,  oftentimes,  because  it  is  so 
easy  for  him  to  avoid  making  good  his  own 
deficiencies  as  long  as  he  can  always  call  on 
somebody  else  when  he  is  at  a  loss.  More- 
over, in  city  practice,  one  misses  much  of 
those  intimacies  with  an  entire  family  which 
make  so  much  of  the  best  rewards  of  country 
practice.  When  one  doctor  attends  the  chil- 
dren of  the  family,  another  the  father,  and 
another  the  mother,  no  one  of  the  three  physi- 
cians is  likely  to  be  as  happily  intimate  with 
the  whole  family  group  as  any  one  of  the 
three  would  be  if  he  took  care  of  the  whole 
family. 

94 


CITY  VS.  COUNTRY  PRACTICE 

To  keep  up  with  medical  progress,  to 
keep  growing  and  to  share  the  inspiration 
which  comes  from  realizing  and  helping  on 
the  development  of  one's  professional  tech- 
nique— all  this  is  far  easier  in  the  city  than  in 
a  small  town.  Hospital  experience,  of  the 
type  that  teaches  us  most,  is  possible  only  in  a 
large  city.  Noted  leaders  of  medicine  are  to 
IDC  heard,  now  and  then,  in  the  larger  centres, 
but  rarely  in  the  smaller  towns.  Public 
health  work,  with  all  that  this  means  for  the 
prevention  of  disease  and  the  enlightenment 
of  practitioners,  can  hardly  be  said  to  exist  at 
the  present  time  except  in  large  cities. 

I  take  it  that  to-day  the  majority  of  physi- 
cians who  settle  in  the  country  do  so  because 
it  is  easier  to  get  a  start  there.  Some  income, 
even  though  a  very  limited  one,  may  be  ex- 
pected during  the  first  year's  work,  while  in 
the  city  this  is  altogether  problematical. 
Moreover,  the  cost  of  living  is  much  higher  in 
a  city.  Anyone  who  has  not  a  nest  egg  in 
the  shape  of  savings  or  capital,  finds  it  very 
precarious  to  face  the  difficulties  of  getting 
started  in  the  city. 

95 


CHAPTER  VIII 

THE  INFLUENCE  OF  DRUGLESS  HEALING, 
CHRISTIAN  SCIENCE,  OSTEOPATHY  AND 
OTHER  SPECIAL  CULTS  ON  DEVELOPMENT 
AND  SUCCESS  OF  THE  DOCTOE 

WHILE  patent  medicines  are  surely  less 
used  by  the  relatively  well  educated  classes 
to-day  than  they  were  fifty  years  ago,  there 
is  an  increasing  number  of  supposedly  edu- 
cated people  who  forsake  their  doctors,  not 
for  patent  medicines  but  for  some  form  of 
unorthodox  healing. 

Christian  Science  appeals  only  to  a  very 
limited  class  of  people,  though  within  that 
class  its  appeal  is  very  powerful.  Far  more 
widespread  to-day  is  the  confidence  in  osteo- 
pathy or  in  the  latest  off-shoot  from  this  stock, 
the  chiropractor.  Homeopathy  bids  fair 
to-day  to  die  out  within  a  short  time  because 
it  is  becoming  increasingly  obvious  that  the 
differences  between  homeopathy  and  the  old 
school  practice  of  medicine  are  so  slight  as 
to  be  negligible.  Homeopathy  flourished 

96 


INFLUENCE  OF  CULTS  ON  SUCCESS 

only  so  long  as  it  was  persecuted.  Now  that 
its  practitioners  are  received  into  the  ordi- 
nary medical  societies  and  welcomed  in  con- 
sultation by  doctors  of  all  schools,  their  in- 
fluence seems  to  be  on  the  decline.  I  think 
that  the  homeopaths  have  suffered  more  from 
the  competition  of  the  osteopaths  than  from 
any  other  single  source.  People  go  to  a 
homeopathist  often  because  they  do  not  want 
to  take  drugs  in  the  ordinary  quantities.  But 
the  osteopath  goes  the  homeopathist  one  bet- 
ter, for  he  gives  no  drugs  at  all,  so  long  as 
he  practices  in  accordance  with  his  oath  of 
registration.  To-day  the  osteopath,  in  turn, 
is  beginning  to  suffer  by  competition  with 
the  chiropractor  whose  education,  being  even 
briefer  and  more  deficient  than  that  of  the 
osteopath,  has  cost  him  less  and  whose  prices 
are  therefore  often  lower. 

Besides  the  groups  of  unorthodox  prac- 
titioners just  referred  to,  there  are,  of  course, 
a  multitude  of  healing  cults  and  irregulars 
of  various  types,  such  as  the  Chinese  herb 
doctor,  the  proprietor  of  magnetic  healing 
springs  and  numberless  others. 
7  97 


TRAINING  OF  THE  PHYSICIAN 

Competition  from  all  these  sources  is  good 
for  a  well  educated  physician,  in  certain  re- 
spects. In  the  first  place  it  takes  away  his 
absolute  and  unchallenged  authority.  No 
one  ought  to  have  that  sort  of  authority.  It 
is  good  for  us  to  be  forced  to  hold  our  own 
without  any  advantage  of  this  sort.  Criti- 
cism challenges  us  to  make  good  and  if  we 
are  not  "  the  only  pebble  on  the  beach  "  we 
are  much  more  likely  to  hold  ourselves  up  to 
high  standards  of  performance.  Our  natural 
tendency  to  slovenly  work  is  opposed  by  the 
consciousness  that  our  mistakes  and  short- 
comings play  into  the  hands  of  irregular 
practitioners. 

Moreover,  we  are  constantly  reminded, 
especially  through  the  activities  of  the  Chris- 
tion  Scientists  and  osteopaths,  of  real  faults 
or  shortcomings  in  our  work.  It  is  the  doc- 
tor's traditional  and  habitual  disregard  for 
the  mental  side  of  disease  that  has  created 
and  fostered  the  growth  of  Christian  Science, 
New  Thought  and  other  cults  which  often 
lay  undue  stress  upon  the  influence  of  the 
mind  over  the  body  and  accent  the  importance 

98 


INFLUENCE  OF  CULTS  ON  SUCCESS 

of  religion  in  all  that  vitally  concerns  the 
sick  man  equally  with  the  well  man. 

So  long  as  psychology  and  the  study  of 
personality  are  altogether  neglected  in  our 
medical  schools  as  well  as  in  our  pre-medical 
education,  we  shall  continue  to  suffer  from 
the  competition  of  those  who  are  strong  where 
we  are  weak. 

Another  weakness  of  orthodox  medicine 
is  this:  The  patient  who  goes  to  a  doctor's 
office  ordinarily  gets  no  immediate  relief  for 
his  sufferings.  He  gets  some  advice  or  a 
prescription  but  though  these  may  lead  to 
improvement  later  on,  he  ordinarily  feels 
no  better  when  he  comes  out  of  a  doctor's 
office.  The  osteopath,  on  the  other  hand, 
can  give  him  immediate  relief.  People  go 
to  his  office  sick  and  come  out  of  it  less  sick. 
It  is  true  that  the  relief  is  often  very  tran- 
sient and  that  one  has  to  go  back  again  and 
again  to  get  treatments.  Nevertheless,  so 
long  as  we  continue  to  "  want  what  we  want 
when  we  want  it,"  we  shall  be  thankful  to 
whoever  will  give  us  some  alleviation  of  our 
sufferings  without  delay.  It  should  be 

99 


TRAINING  OF  THE  PHYSICIAN 

pointed  out  however  that  the  weakness  of 
osteopathy,  corresponding  to  the  advantage 
just  described,  is  that  osteopathic  treatment 
tends  never  to  come  to  an  end.  One  goes  back 
again  and  again  instead  of  getting  radical 
cure,  or  where  that  is  impossible,  settling 
down  to  bear  one's  ills,  with  or  without  a  grin. 
We  are  often  asked  why  we  do  not  add 
the  perfectly  real  relief  which  the  osteopathic 
treatment  gives  to  our  armamentarium  of 
remedies.  Why  should  we  not  advise  people 
as  to  hygiene,  give  them  medicine  and  surg- 
ery, where  those  are  needed,  and  also  man- 
ipulate their  sore  bodies,  as  the  osteopaths  do? 
The  simple  answer  is,  I  think,  that  most  doc- 
tors do  not  like  that  sort  of  work.  If  they 
had  to  make  a  living  with  their  muscles  prim- 
arily, they  would  choose  some  other  occupa- 
tion. Why,  then,  doesn't  the  doctor  refer  his 
patients  to  osteopaths  or  to  skillful  masseurs 
for  the  immediate  relief  which  he  cannot 
give?  Sometimes  because  he  fears  competi- 
tion and  is  afraid  he  will  lose  his  patient. 
Sometimes  because  he  realizes  that  the  oste- 
opathic theory  is  absurd,  even  though  its 

100 


INFLUENCE  OF  CULTS  ON  SUCCESS 

practice  may  be  decidedly  successful.  Some- 
times because  he  believes  that  the  patient 
should  have  either  radical  study  of  his  case, 
such  as  leads  to  the  finding  and  removal  of 
the  causes  of  disease,  or,  if  this  is  impossible, 
should  live  his  life  in  spite  of  his  troubles 
rather  than  acquire  the  habit  of  accepting 
treatment  every  few  days. 

On  these  points  it  must  be  recognized  that 
the  patient  may  have  a  different  opinion.  I 
have  set  them  forth  to  explain  rather  than  to 
justify  the  doctor's  attitude. 

The  irregular  healers  of  various  cults  have 
their  vogue  not  only  for  the  reasons  just 
given  but  also  because  they  generally  unite 
in  condemning  surgical  operations.  A  pa- 
tient is  told  by  a  doctor  that  he  must  have  a 
surgical  operation  performed.  He  naturally 
dreads  it  and  seeks  relief  elsewhere.  The 
Chinese  herb  doctor,  the  Christian  Scientist, 
the  Osteopath  all  agree  in  telling  him  that  he 
needs  no  operation.  This  is  an  immense  re- 
lief, especially  as  in  many  cases  no  disaster 
follows  disregard  of  the  surgeon's  warnings. 
This  is  possible,  of  course,  only  because  far 

101 


TRAINING  OF  THE  PHYSICIAN 

too  many  operations  are  to-day  advised.    As 
long  as  surgeons  are  as  reckless  as  they  now 
are  in  advising  operation,  the  irregular  prac- 
titioner will  continue  not  only  to  flourish  but 
to  do  a  certain  public  service  in  encouraging 
people  to  disregard  the  surgeon's  false  advice. 
Among  the   disadvantages  of   the   rank 
growth  of  irregular  medical  cults  at  the  pres- 
ent time  is  the  encouragement  that  it  gives 
to  sheer  fickleness  and  faithlessness  on  the 
part  of  the  sick.    Anyone  who  does  not  get 
well  as  fast  or  as  easily  as  he  thinks  he  should, 
is  naturally  tempted  to  blame  his  doctor. 
Sometimes  the  doctor  is  at  fault,  but  not  al- 
ways, by  any  means.    The  presence  of  osteo- 
pathy, chiropractice  and  mental  healers  of 
various  types,  advertising  their  wares  by  legi- 
timate or  illegitimate  means,  tends  to  in- 
crease the  natural  fickleness  of  mankind  and 
brings  upon  reputable  physicians,  not  only 
such  blame  as  they  often  deserve  but  also 
quite  groundless  and  unfair  criticism.     For 
the  patient,  as  well  as  for  the  doctor,  a  fre- 
quent change  of  medical  attendants  is  most 
undesirable,  sometimes  disastrous.    This  evil 

102 


INFLUENCE  OF  CULTS  ON  SUCCESS 

is  more  rampant  the  less  education  and  the 
less  common  sense  people  have ;  but  it  is  more 
or  less  prevalent  everywhere  to-day.  Anoth- 
er, though  less  costly,  evil  resulting  from  the 
multiplication  of  unscientific  healing  cults 
is  the  mental  disorganization  and  dissipation 
resulting  from  their  attractive  presentation 
of  false  theories  as  to  the  nature  of  disease 
and  its  cure.  I  believe  that  all  the  healing 
cults,  from  Christian  Science  down,  do  a  cer- 
tain amount  of  indubitable  good.  But  many 
people  are  prone  to  argue  from  this  fact  that 
the  theories  behind  the  cults  must  also  be 
more  or  less  true.  The  inference  is  unsound. 
The  theories  or  supposed  discoveries  back  of 
the  successful  work  of  the  osteopath  and 
the  Chinese  herb  doctor  are  obviously  and 
demonstrably  false.  To  accept  them,  never- 
theless, because  one  finds  that  their  practice 
gives  relief  is  very  bad  for  mental  health  and 
tends  to  loose  thinking  about  many  mat- 
ters more  important  than  health. 

Another  evil,  to  which  all  the  heretical 
sects  of  healing  contribute  to  a  greater  or 
lesser  degree,  is  the  attack  which  they  make 

103 


TRAINING  OF  THE  PHYSICIAN 

upon  public  health  by  measures  introduced 
into  the  legislature.  When  the  anti- vaccina- 
tion cranks  are  to  the  fore,  they  are  apt  to 
be  supported  by  Christian  Scientists,  osteo- 
paths and  other  irregular  healers  whose  total 
influence  upon  legislators  may  be  very  con- 
siderable. Every  advance  in  the  effective- 
ness of  public  health  administration  is  apt  to 
be  fought  by  this  dangerous  combination. 
They  unite  with  the  anti-vivisectionists,  the 
vegitarians  and  other  special  sects  to  obstruct 
work  which  may  be  of  vital  importance  to  the 
public  health. 


104 


CHAPTER  IX 

THE  INFLUENCE  OF  IMPORTANT  PUBLIC 
HEALTH  "  CRUSADES  "  ON  MEDICAL  DE- 
VELOPMENT AND  MEDICAL  PRACTICE 

1.  THE  FIGHT  AGAINST  TUBERCULOSIS 

THE  oldest  and  most  important  of  the 
crusades  against  disease  which  have  started 
within  the  present  generation,  is  that  against 
tuberculosis.  A  good  example  of  how  such 
a  crusade,  conducted  in  considerable  part 
through  newspaper  publicity,  may  react 
upon  the  work  of  the  private  practitioner,  is 
given  in  the  following  letter. 

"  In  the  early  fall  of  1902,  I  was  much 
annoyed  by  an  irritated  throat,  which  caused 
a  constant  hacking  cough  at  any  attempt  to 
talk.  Conversation  was  difficult,  for  it  occa- 
sioned a  dry  hacking  cough  constantly. 

"  In  December,  1902,  or  January  follow- 
ing, I  began  to  have  profuse  night  sweats, 
which  continued  until  September,  1903.  I 

105 


TRAINING  OF  THE  PHYSICIAN 

was  told  by  my  physician  that  these  night 
sweats  should  not  be  checked,  as  it  was  the 
means  of  eliminating  great  quantities  of  poi- 
son from  my  system.  The  sweat  suddenly 
ceased  upon  the  use  of  Tokay  grapes  some- 
thing over  a  pound  a  day.  At  the  same  time 
my  secretion  of  urine  very  largely  increased. 
The  grapes  may  have  had  nothing  to  do  with 
it,  but  there  was  no  other  change  in  my  diet 
or  mode  of  life  at  that  time  to  which  I  could 
attribute  the  change. 

"  During  the  months  of  January,  Febru- 
ary, and  March,  1903,  I  suffered  from  what 
my  physician  termed  "  grip."  My  throat 
became  more  and  more  troublesome.  He 
tried  various  remedies,  which  had  no  effect. 
Early  in  April  I  attended  a  funeral  in  which 
I  was  one  of  thirty  packed  into  a  small,  un- 
ventilated,  low,  hot  room  for  nearly  an  hour, 
during  which  I  perspired  profusely.  I  was 
then  seated  in  an  open  carriage,  sat  a  long 
time  in  the  wind,  was  shaking  with  cold  when 
I  reached  home,  and  was  very  much  worse 
immediately  following.  For  a  fortnight  I 
coughed  continually,  night  and  day.  My 

106 


INFLUENCE  OF  HEALTH  CRUSADES 

throat  grew  painful,  my  cough  very  much 
increased. 

"  My  regular  physician  fell  ill.  About 
June  first,  1903,  I  consulted  another  physi- 
cian regarded  as  eminent  in  his  profession, 
and  a  man  of  long  experience.  I  had  then 
lost  about  ten  pounds  in  weight.  He  exam- 
ined me  carefully,  examined  my  sputa,  found 
tubercle  bacilli,  found  my  water  showed  a 
large  amount  of  uric  acid.  He  physicked  me 
severely  for  about  three  weeks,  during  which 
time  I  lost  eight  pounds  more  in  weight.  I 
protested  using  physic  longer,  but  continued 
to  take  six  large  tablets  a  day,  the  nature  of 
which  I  do  not  know,  from  about  June  first 
to  August  first. 

"  During  this  period  of  two  months,  noth- 
ing was  said  to  me  in  regard  to  out-door  liv- 
ing, and  I  stayed  nearly  all  the  time  in  a 
room  lying  upon  a  sofa  with  doors  and  win- 
dows closed  to  prevent  people  from  hearing 
my  disturbing  coughing.  I  suffered  great 
lethargy.  Immediately  after  breakfast  each 
day  I  would  find  it  almost  impossible  to  pre- 
vent chills.  Had  to  hold  hot  water  bags  and 

107 


TRAINING  OF  THE  PHYSICIAN 

get  my  feet  in  an  oven  each  morning.  Soon, 
a  feeling  of  lethargy  would  come  over  me 
and  it  would  seem  almost  impossible  for  me 
to  move  or  stir.  During  this  period  of  two 
months,  my  digestion  was  excellent.  I  ate 
very  heartily  of  nutritious  food,  a  large 
amount  of  beefsteak,  and  two  boiled  eggs 
twice  a  day,  and  at  the  end  of  each  meal  took 
in  addition  three  raw  eggs  beaten  up  in  water 
added  to  a  pint  of  milk  with  a  few  teaspoon- 
fuls  of  brandy.  Reported  daily  to  my  phy- 
sician in  whom  I  had  unbounded  confidence. 
"  Beginning  with  about  the  25th  of  July 
and  continuing  for  about  ten  days  I  inhaled 
at  the  direction  of  my  physician,  a  prepara- 
tion which  he  directed  me  to  inhale  three 
times  a  day  as  deeply  and  fully  as  possible 
from  a  very  long-nosed  atomizer.  Each  time 
it  made  me  nearly  crazy.  I  would  simply 
jump  up  and  down  for  five  minutes  follow- 
ing. I  protested  to  my  physician  against  its 
use,  but  he  insisted  it  was  very  important, 
and  the  usual  remedy  in  a  case  like  mine.  At 
the  end  of  ten  days  my  respiratory  organs 
had  become  unendurably  sore  and  my  cough 

108 


INFLUENCE  OF  HEALTH  CRUSADES 

very  much  increased,  so  that  I  coughed  al- 
most constantly  night  and  day.  I  then  tried 
the  experiment  of  spraying  my  skin  extern- 
ally with  the  preparation,  and  found  that  the 
spray  created  a  blister  that  required  a  week 
to  heal.  I  then  refused  to  use  this  longer.  I 
afterwards  learned  that  the  preparation  con- 
sisted of  alcohol,  chloroform,  and  creosote. 
The  odor  of  creosote  was  very  strong.  Since 
that  time  I  have  taken  no  manner  of  medi- 
cine other  than  one  lithia  tablet,  much  of  the 
time,  daily. 

"  About  the  first  of  August,  my  attention 
was  called  to  the  four  articles  in  the  Review 
of  Reviews  for  June,  1903,  in  reference  to 
out-door  treatment  of  tuberculosis.  I  then 
began  to  read  everything  I  could  find  touch- 
ing this  treatment,  and  through  the  months 
of  August  and  September  kept  out-doors  a 
good  portion  of  the  day  and  under  the  advice 
of  physicians,  took  as  much  exercise  as  possi- 
ble. After  my  afternoon  naps  would  chop 
low  limbs  from  small  pine  trees. 

"  I  was  examined  August  11,  1903,  by  an 
eminent  specialist  on  throat  diseases,  of 

109 


TRAINING  OF  THE  PHYSICIAN 

Boston,  who  assured  me  that  he  found  no 
trouble  with  my  throat,  and  regarded  its 
then  condition  due  entirely  to  over-treat- 
ment. During  September  my  throat  much 
improved,  became  practically  well  and  has 
not  troubled  since.  During  August  and 
September,  I  drove  out  several  miles  from 
my  house  daily  in  the  morning,  remained  all 
day,  and  returned  at  night.  This  was  an 
unusually  dry  period,  and  the  streets  were 
very  dusty.  It  often  seemed  impossible  to 
endure  the  rides,  so  heavy,  dull,  and  tired 
did  I  feel. 

'  The  last  day  of  September  I  was  exam- 
ined by  a  specialist  on  tuberculosis,  and  a 
few  days  later  received  Dr.  Flick's  little  book 
on  the  prevention  and  cure  of  tuberculosis, 
for  which  I  had  previously  sent,  and  which 
was  published  about  October  1,  1903.  From 
the  specialist  and  from  this  book  I  learned 
that  exercise  was  not  beneficial. 

"  My  temperature  during  June  and  July, 
I  was  informed  about  the  end  of  that  period 
by  my  physician,  had  been  103°.  At  that 
time  I  knew  nothing  about  'temperature*  nor 

no 


INFLUENCE  OF  HEALTH  CRUSADES 

fever,  nor  consumption  nor  its  symptoms.  I 
had  been  intensely  busy  over  matters  in  my 
own  profession.  I  understood  during  those 
two  months  that  my  lethargy,  or  dull,  tired 
feeling  was  due  to  sluggish  liver. 

"  During  September  my  temperature  ran 
about  101°  from  say  ten  to  six  or  seven. 
October  1, 1  ceased  taking  exercise  and  driv- 
ing; remained  on  my  back  porch  all  day, 
taking  my  meals  there,  and  I  slept  in  a  room 
with  five  windows,  two  on  the  north  side, 
one  on  the  east  side,  which  were  open  half 
way,  and  two  upon  the  south  side  which 
were  taken  out.  When  the  extreme  cold 
weather  came  I  had  to  put  in  the  south  win- 
dows to  save  plumbing  in  my  house,  but  slept 
with  two  windows  down,  one  on  north  and 
one  on  south  side. 

"  During  the  months  of  October  and  Nov- 
ember I  increased  in  weight  twenty  pounds, 
and  about  the  20th  of  November  my  temp- 
erature had  become  normal  and  had  no  rise." 

The  moral  of  this  document  seems  to  me 
this:  A  patient  who  otherwise  might  be  at 
the  mercy  of  whatever  degree  of  ignorance 
ill 


TRAINING  OF  THE  PHYSICIAN 

his  family  physician  might  be  doomed  to 
possess,  is,  through  the  channels  of  a  popular 
magazine,  given  a  chance  to  climb  out  of  the 
Slough  of  Despond.  Similarly,  a  practitioner 
to  whom  modern  discoveries  might  otherwise 
not  be  conveyed  with  any  degree  of  urgency 
through  the  dull  columns  of  scientific  medi- 
cal magazines,  may  through  the  livelier  and 
more  insistent  appeals  of  newspapers,  cir- 
culars and  magazines,  or  through  the  still 
more  appealing  channels  of  popular  lecture 
or  neighborhood  gossip,  get  hold  of  truth 
which  otherwise  he  would  miss. 

The  modern  treatment  of  tuberculosis 
rests  chiefly  upon  facts  which  were  known 
for  many  years  before  they  were  put  into 
practice.  Indeed  many  of  them  have  not 
been  put  into  practice  yet,  for  example  in 
France  and  in  the  more  isolated  sections  of 
this  country.  To  bring  medical  practice  up 
to  the  level  of  the  best  that  is  known  has 
needed,  in  the  field  of  tuberculosis,  a  propa- 
ganda started  and  carried  on  largely  by  lay- 
men, then  taken  up  and  forwarded  by  state 

and  municipal  authorities,  women's  clubs, 

112 


INFLUENCE  OF  HEALTH  CRUSADES 

anti-tuberculosis  associations,  and  other  bod- 
ies representing  the  pressing  needs  of  the 
consumptive  himself. 

All  this  publicity  and  common  talk  is 
against  medical  traditions.  That  things 
should  be  done  quietly,  decently,  and  without 
advertising  is  the  time-honored  custom  of  or- 
ganized medicine.  The  old  adage  that  "  a 
little  knowledge  is  a  dangerous  thing  "  has 
impressed  itself  so  deeply  upon  the  mind  of 
the  medical  profession  that  it  has  prevented 
doctors,  until  very  recently,  from  taking  the 
public  into  their  confidence  or  attempting  to 
put  into  the  sick  man's  hands  the  knowledge 
necessary  for  him  to  take  his  part  in  the  fight 
against  disease.  Doctors  in  the  past  have 
thought  that  they  must  do  it  all,  and  that  the 
patient  should  not  be  allowed  to  waste  his 
strength  or  bewilder  his  mind  by  trying  to 
fight  disease  himself.  A  change  in  our  be- 
liefs upon  this  matter  is  now  reacting  favora- 
bly I  think  not  only  upon  the  health  of  the 
community,  but  upon  the  development  of 
the  private  practitioner  towards  better 
knowledge  and  control  of  tuberculosis. 

R  113 


TRAINING  OF  THE  PHYSICIAN 

In  another  way,  moreover,  the  doctor  is 
stimulated  and  jacked  up,  by  the  modern 
anti-tuberculosis  crusade.  The  lay  members 
of  this  crusade  quite  naturally  "  play  the 
game  with  their  cards  on  the  table."  They 
have  nothing  to  conceal.  They  deal  in  a  re- 
freshingly direct  and  simple  way  with  such 
patients  and  families  as  may  be  influenced  by 
their  educational  propaganda.  The  doctor 
who  for  generations  has  been  accustomed  to 
soften  or  color  the  truth  in  order  to  save  the 
feelings  of  his  patients  and  keep  them  cheer- 
ful and  content,  has  now  to  meet  competition 
with  the  methods  of  those  who  believe  that 
everybody  who  has,  or  is  in  danger  of  having, 
tuberculosis  needs  all  the  knowledge  he  can 
get,  and  should  be  dealt  with  in  the  frankest 
and  most  straightforward  way.  Health  offi- 
cials, social  workers,  public  health  nurses, 
now  talk  about  tuberculosis  in  a  way  quite 
revolutionary  from  the  point  of  view  of  the 
every-day  practitioner  twenty-five  years  ago. 
To  one  who  believes,  as  I  do,  in  telling  the 
truth  in  medicine,  all  this  is  great  gain. 
Truth  tellers  in  competition  with  those  who 

114 


try  to  give  the  patient  something  better,  are 
sure,  I  believe,  to  win  out,  and  this  will  be 
one  of  the  surest  means  of  converting  physi- 
cians to  a  belief  in  total  veracity  as  a  potent 
weapon  in  the  cure  of  disease. 

Moreover,  habits  of  direct  dealing  ac- 
quired in  the  management  of  one  disease,  like 
tuberculosis,  are  pretty  sure  to  spread  and 
to  revolutionize  the  methods  used  in  dealing 
with  other  diseases.  Thus  the  whole  lump 
of  medical  conservatism  becomes  leavened. 

The  anti-tuberculosis  crusade  was  also  the 
first  step  in  rendering  it  possible  for  reputa- 
ble physicians  to  appear  in  the  public  prints 
and  daily  papers  as  instructors  of  their  fel- 
low-citizens. Until  comparatively  recent 
times  it  was  considered  unethical  for  a  physi- 
cian to  talk  for  publication.  It  appeared 
that  he  could  do  so  only  to  advance  his  own 
interest,  in  other  words,  as  a  means  of  adver- 
tising himself.  It  is  probably  true  that  every 
physician  who  now  talks  for  publication  on 
matters  of  public  health  does  advertize  him- 
self and  benefit  his  own  pocket  to  a  certain 
extent.  But  the  crying  need  of  general  edu- 

115 


TRAINING  OF  THE  PHYSICIAN 

cation  about  health  and  disease  has  made  us 
now  willing  to  condone  or  even  to  encourage 
the  appearance  of  medical  men  in  the  news- 
papers, provided  they  never  discuss  their 
own  private  ideas  or  proficiencies,  never  sug- 
gest directly  or  indirectly  that  the  reader 
should  patronize  the  writer,  but  confine  them- 
selves wholly  to  bringing  home  to  the  reader 
what  he  needs  to  know  about  his  own  health 
and  about  diseases  which  may  attack  him. 
Until  recent  times  the  doctors  who  are  the 
only  people  of  unusual  competence  to  dis- 
cuss medical  matters  in  public,  were  not  al- 
lowed to  do  so  because  of  the  limitations  of 
medical  etiquette.  This  blunder  has  been 
remedied,  largely  owing  to  the  urgency  of 
the  lay  members  of  the  anti-tuberculosis 
crusade,  who  have  enlisted  the  services  of 
physicians  as  lecturers  and  publicity  writers. 

2.    ORGANIZED     EFFORT     TO     CHECK     INFANT 
MORTALITY 

IT  has  long  been  realized  by  the  specialists 
in  children's  diseases  and  by  others  usually 
cognizant  of  the  facts,  that  infant  mortality 

116 


Playthings — an  aid  in   the  office  when  examining  young  children. 


INFLUENCE  OF  HEALTH  CRUSADES 

could  be  considerably  curtailed  through 
teaching  mothers  how  to  take  care  of  their 
children.  The  old  idea  that  women  have  a 
congenital  skill  or  hereditary  intuition  in  such 
matters  has  gradually  been  broken  down,  as 
we  have  come  to  realize  that  the  care  of  a 
baby  is  something  which  can  and  must  be 
learned  like  anything  else.  This  is  not  the 
place  to  discuss  the  good  effect  produced 
upon  public  health  by  the  spread  of  this 
knowledge  through  the  agency  of  societies 
for  child  hygiene,  for  pure  milk  supplies,  and 
the  like.  What  interests  us  here  is  to  note 
that  the  best  knowledge  about  the  care  of 
young  children  has  been,  through  these  lay 
agencies,  forced  upon  the  attention  of  the 
medical  profession  as  a  whole,  in  a  degree 
that  has  proved  vastly  beneficial  though  it 
still  leaves  much  to  be  desired.  What  the 
physician  failed  to  learn  in  the  medical  school 
or  from  medical  journals  he  is  now  on  the 
way  to  pick  up  through  lectures,  circulars, 
and  gossip  emanating  from  one  or  another 
children's  crusade  of  lay  origin. 

A  good  deal  of  the  teaching  which  now 

117 


TRAINING  OF  THE  PHYSICIAN 

comes  to  young  mothers  either  through  lay 
agencies  or  through  the  physicians  them- 
selves, tends  to  cut  down  the  physician's  in- 
come. I  have  told  elsewhere1  a  true  story 
which  I  may  be  here  permitted  to  repeat. 

I  was  talking  once  with  a  physician  who 
was  telling  me  how  he  had  lost  practice  and 
money  in  the  treatment  of  babies. 

He  said,  "  I  do  not  now  see  one  baby  for 
every  ten  I  used  to  see." 

I  said,  "  Well,  why  is  that?" 

"  It  is  like  this,"  he  said.  "  A  lady  called 
me  up  the  other  day,  and  told  me  her  baby 
had  a  little  trouble  in  his  bowels.  '  I  have 
stopped  all  food,'  said  she,  '  given  water  in 
plenty,  and  one-tenth  grain  of  calomel  every 
hour  for  five  doses.  Is  there  anything  else 
I  ought  to  do  for  the  baby?  '  I  said  no,  not 
just  now.  'Well,'  she  said,  'if  the  baby 
is  not  better  soon  I  shall  want  you  to  come 
and  see  him.'  But  the  baby  was  better,  and 
I  was  never  called.  I  had  taught  the  mother 

1  A  Layman's  Handbook  of  Medicine  (Hough- 
ton  Mifflin  Co.),  p.  155. 

118 


INFLUENCE  OF  HEALTH  CRUSADES 

all  she  knew  and  most  that  I  knew  about 
babies." 

This  occurrence  shows  how  an  educa- 
tional impulse,  starting  often  through  non- 
medical  agencies  and  adopted  by  the  physi- 
cian himself,  is  often  carrying  him  very  much 
beyond  and  against  his  own  pecuniary  inter- 
est. He  feels  the  public  good  so  insistently 
and  sees  so  clearly  the  direction  of  its  ad- 
vance, that  he  forgets  himself,  sacrifices  him- 
self without  stopping  to  think  of  his  own  in- 
terest. Surely  this  is  for  the  good  of  the  pro- 
fession, as  well  as  of  the  public. 


119 


CHAPTER  X 

THE  HEALTH  CRUSADES  AGAINST  TYPHOID, 
MALARIA  AND  OTHER  PREVENTABLE 

DISEASES 

THE  active  work  of  public  health  officers 
and  sanitary  engineers  in  tracking  down  the 
sources  of  an  epidemic  of  typhoid  fever  or 
septic  sore  throat, — tracing  it  to  an  infected 
milk  supply  or  an  impure  water  supply,— 
is  of  value  in  the  development  of  the  practic- 
ing physician,  not  only  because  such  work 
brings  him  stimulating  competition  as  be- 
cause it  keeps  before  his  mind  an  attitude 
about  disease  which  he  is  always  in  danger  of 
forgetting,  the  attitude,  namely,  of  a  militant 
attack  upon  the  sources.  The  doctor's  prime 
business  is  to  discover  and  to  treat  individual 
cases  of  sickness.  But  the  community  will 
never  be  satisfied  with  this  alone.  It  always 
looks  to  the  doctor  for  some  effort  of  preven- 
tion, some  effort  for  the  wholesale  destruc- 
tion of  disease  as  well  as  for  sniping  activities 

120 


r*-*       *«  \ 

..,5r<^  /-^?*x 

"  ^-" 


^ 


•••-•s  %" 


-..   ., 

•  *-"-^"  **"-•*'  ,-"f  .- 

r' •  f       «- 


A  mosquito-map  of  New  Orleans;  fly  maps  should  be  made  in  the  same 
way.     (After  Boyer.) 


PREVENTABLE  DISEASES 

against  particular  cases.  This  may  be  called 
the  "  harrying  motive  "  or  the  abolitionist's 
motive.  It  is  the  chief  business  of  the  health 
officer  and  through  his  activities  it  is  brought 
from  time  to  time  within  the  ken  of  the  doc- 
tor who  otherwise  tends  to  forget  it  and  to 
stick  to  his  ordinary  activities  at  retail.  Dis- 
ease, as  it  happens  along  and  appears  at  a 
doctor's  office  or  through  a  telephone  call, 
must  be  attended  to  with  the  best  of  the 
doctor's  ability,  but  he  is  in  danger  of  for- 
getting that  from  the  public's  point  of  view, 
this  is  only  one  of  the  ways  in  which  he  can 
fight  disease.  As  people  undertake  radical 
campaigns  against  inundations  from  the 
ocean,  against  river  floods,  against  insect 
pests,  so  militant  and  systematic  attempts  to 
root  out  disease  must  go  hand  in  hand  with 
efforts  to  cure  individual  cases  and  to  save 
suffering.  Modern  public  health  work  tends 
to  keep  the  doctor  up  to  his  job  on  this  side 
of  his  work. 

The  crusade  against  poliomyelitis,  or  in- 
fantile paralysis,  has  been  absolutely  unsuc- 
cessful so  far  as  any  effect  upon  the  disease 

121 


TRAINING  OF  THE  PHYSICIAN 

is  concerned.  Yet  it  has  been  stimulating 
and  useful  to  the  medical  men  because  it  has 
brought  their  diagnostic  activities  into  com- 
petition with  those  of  experts  trained  by  un- 
usual experience  with  this  particular  disease. 
During  the  recent  extensive  epidemic  in  New 
York  City,  the  N.  Y.  Board  of  Health  em- 
ployed expert  diagnosticians  to  verify  the 
private  practitioner's  findings  before  allow- 
ing cases  to  be  admitted  to  the  public  hospit- 
als. This  sort  of  checking  up  by  experts  is 
very  salutary  for  all  of  us. 


122 


CHAPTER  XI 

THE  PRIVATE  PRACTITIONER'S  COMPETITION 
WITH  GROUP  MEDICINE 

GROUP  medicine,  or  the  effort  of  doctors 
and  others  to  work  in  teams,  with  proper  sub- 
divisions of  labor  and  specialization  of  func- 
tion, such  as  is  characteristic  of  other  depart- 
ments of  industry,  is  a  feature  of  modern 
medical  work  viewed  often  with  hatred  or 
alarm  by  private  practitioners.  The  most 
familiar  form  of  this  antagonism  is  directed 
against  hospitals,  which  are  the  oldest  and 
most  obvious  form  of  group-work  for  the 
benefit  of  sick  people.  In  the  past,  hospitals 
at  which  group  work  was  done  were  almost 
exclusively  for  the  poor  and  were  not  there- 
fore brought  into  comparison  with  the  work 
and  the  efforts  of  the  private  practitioner  to 
earn  his  living.  Of  late  years,  however,  hospi- 
tals, especially  of  the  type  started  and  main- 
tained by  the  Mayo  Brothers,  at  Rochester, 
Minn.,  have  begun  to  furnish  to  patients  of 

123 


TRAINING  OF  THE  PHYSICIAN 

moderate  or  immoderate  means  the  same  op- 
portunity for  study  by  groups  of  specialists 
representing  different  sides  of  medical  work 
as  has  long  been  available  for  the  poor  in  the 
better  free  hospitals  of  the  country.  The 
competition  which  thus  arises  is  not  a  compe- 
tition between  individual  doctors,  but  be- 
tween doctors  as  individuals  and  a  group  who 
work  together  as  a  team,  each  doing  the  part 
that  he  has  fitted  himself  especially  to  do  and 
dove-tailing  in  with  the  work  of  others  simi- 
larly skilled  in  other  fields.  This  sort  of  a 
working  group,  provided  it  is  honest  and 
above-board  in  all  its  methods,  is  bound  to 
bring  home  to  private  practitioners  the  anom- 
aly of  their  isolated  and  unorganized  position, 
especially  now  when  the  complications  of 
medical  diagnosis  and  the  varied  types  of  skill 
needed  in  medical  and  surgical  treatment  are 
becoming  more  and  more  elaborate.  Out- 
spoken hostility  against  groups  such  as  that 
organized  by  the  Mayos,  is  now  beginning  to 
die  out  since  the  overwhelming  success  and 
public  approval  of  the  plan  has  made  its  po- 
sition secure.  Such  group  work  is  therefore 

124 


COMPETITION  WITH  GROUP  MEDICINE 

multiplying  very  fast  and  is  bound  to  keep 
the  private  practitioner  constantly  on  his 
mettle  if  he  stays  out  of  such  groups  and  to 
urge  upon  his  attention  the  desirability  of 
getting  into  one  of  them. 

I  have  already  referred  to  the  work  of 
public  health  laboratories  and  public  health 
diagnosticians  as  one  of  the  elements  helping 
to  keep  the  private  practitioner  up  to  date. 
One  of  the  most  striking  examples  of  the  ad- 
vantage of  public  over  private  enterprise  in 
the  field  of  medical  diagnosis  and  treatment 
was  revealed  at  a  recent  meeting  in  Washing- 
ton, D.  C.,  at  which  the  Health  Commis- 
sioner of  one  of  the  leading  states  of  the  Un- 
ion said  that  the  Board  of  Health  in  his  State 
was  now  making  salvarsan  ("606")  at  a 
cost  of  40  cents  a  dose  and  doing  Wasser- 
mann  tests  at  an  actual  cost  of  about  30  cents 
per  test.  In  the  open  market  Wassermann 
tests  cost  from  $5.  to  $25.  and  salvarsan  from 
$3.  to  $5.  a  dose.  This  kind  of  contrast  be- 
tween public  and  private  work  cannot  long 
continue  when  once  the  public  becomes  en- 
lightened. 

125 


TRAINING  OF  THE  PHYSICIAN 

The  more  enlightened  employers  of  large 
industrial  groups  have  begun  within  the  last 
ten  years  to  organize  medical  care  for  the  em- 
ployees, to  hire  physicians  on  full  time  and 
thereby  to  give  the  practitioners  of  the  towns 
wherein  these  industrial  plants  are  situated 
a  demonstration  of  what  group  work  can  do 
both  in  the  profession  and  in  the  treatment  of 
disease.  The  medical  department  of  such  a 
corporation  views  disease  wholesale  and  in 
the  aggressive  spirit  which  I  have  already 
described  in  connection  with  public  health 
work.  The  vital  importance  of  this  attitude 
to  the  community  is  therefore  kept  before 
the  physician  practicing  in  the  neighborhood 
of  these  plants. 

The  work  of  the  public  health  nurses  rep- 
resenting private  philanthropic  groups,  life 
insurance  companies  or  municipal  health 
boards,  should  be  and  often  is  a  potent  aid 
to  the  practitioner  who  would  otherwise  be 
discouraged  in  undertaking  the  care  of  pa- 
tients in  need  of  constant  nursing  and  unable 
to  pay  for  it.  The  attendance  of  a  nurse 
makes  it  possible  for  the  physician  to  visual- 

126 


COMPETITION  WITH  GROUP  MEDICINE 

ize  the  condition  of  his  patient  during  the 
many  hours  when  he  himself  is  not  in  attend- 
ance. Thereby,  with  the  nurse's  help,  he  gets 
a  much  truer  idea  of  what  is  going  on  and 
should  be  enabled  to  shape  his  treatment  more 
effectively.  This  is  always  the  case  except 
when  the  nurse  is  so  well  trained  and  the 
doctor  so  illtrained  that  her  presence  and 
knowledge  constitutes  a  challenge  or  a  criti- 
cism which  he  resents  and  fears.  The  nurse, 
then,  appears  either  as  a  doctor's  efficient  aid 
or  as  his  enemy.  To  the  better  type  of  phy- 
sician, she  is  always  and  only  a  benefit. 

The  health  work  organized  in  public 
schools  under  municipal  auspices  and  gener- 
ally called  the  medical  inspection  of  school 
children,  is  still  in  its  infancy  in  this  country 
and  as  yet  has  not  advanced  beyond  the  stage 
of  enumerating  diseases  and  defects  unreme- 
died.  Only  in  the  field  of  dental  work  have 
we,  in  a  few  cities,  advanced  beyond  diagnosis 
to  treatment.  Thus,  at  the  present  time, 
medical  work  organized  under  municipal 
auspices  in  schools  comes  into  comparatively 
little  contact  with  the  practitioner's  field  of 

127 


TRAINING  OF  THE  PHYSICIAN 

work,  and  as  the  salaries  of  school  physicians 
are  generally  too  low  to  attract  high  grade 
men,  one  cannot  say  the  medical  profession 
has  been  benefited  to  any  extent  in  its  devel- 
opment or  organization  by  municipal  school 
work. 

Another  agency  which  has  modified  very 
strikingly  of  late  years  the  attitude  of  the  av- 
erage patient  to  the  average  doctor  is  the 
mass  of  health  tracts,  health  circulars  and 
health  essays  sent  out  through  the  great  life 
insurance  companies,  through  the  daily  pa- 
pers and  the  magazines.  The  quality  of  this 
literature  is  now,  on  the  whole,  very  high  and 
the  amount  of  accurate  information  thus 
being  conveyed  to  the  public  is  large.  All 
this  educational  effort  should  make  it  easier 
for  the  practicing  physician  to  accomplish 
his  natural  tasks  for  the  patient.  The  medi- 
cally educated  patient  knows  what  to  expect 
and  can  accept  more  docilely  what  his  doctor 
has  to  impress  upon  him.  Moreover,  the  pa- 
tient can  co-operate  far  better  (because  more 
intelligently)  in  the  measures  of  relief  which 
the  doctor  has  to  present.  Every  honest  phy- 

128 


COMPETITION  WITH  GROUP  MEDICINE 

sician  prefers  to  practice  among  intelligent 
people  and  hence  the  great  bulk  of  medical 
literature  and  medical  information  now 
reaching  that  portion  of  the  public  which 
reads,  makes  it  more  satisfactory  to  practice 
medicine  today  than  it  ever  has  been  before 
in  this  country. 


129 


PART  III 

THE  REWARDS 


CHAPTER  XII 

THE  REWARDS  OF  MEDICAL  WORK 
BEFORE  describing  the  rewards  which  a 
doctor  may  reasonably  expect  to  find  in  his 
professional  work  I  wish  to  give  some  warn- 
ing as  to  what  he  should  not  expect.  False 
expectations  die  with  less  pain  if  they  are 
killed  off  in  youth  or  if  possible  in  the  egg. 
Hence  in  a  book  meant  for  those  expecting 
to  study  medicine  it  seems  well  to  forestall,  if 
I  can,  certain  disappointments. 

THE  DOCTOR'S  FINANCES 
Among  the  rewards  which  the  doctor  can- 
not expect  is  wealth.  Few  doctors  have  ever 
grown  rich  from  their  medical  fees,  and  if  I 
read  the  signs  of  the  times  rightly  the  num- 
ber of  doctors  with  incomes  above  $5000.  a 
year  is  going  to  be  smaller  in  the  future  than 
in  the  past.  Especially  in  America  where 
the  number  of  doctors  in  proportion  to  popu- 
lation is  greater  than  in  any  other  country, 
it  stands  to  reason  that  each  doctor  will  get 
less  than  he  needs  for  comfort,  unless  indeed 

133 


TRAINING  OF  THE  PHYSICIAN 

it  could  be  shown  that  we  are  especially  prone 
as  a  nation  to  call  (and  pay)  a  doctor  and 
no  one  else  when  we  are  sick.  But  in  fact  the 
reverse  of  this  is  true.  We  call  at  an  apothe- 
cary's shop  and  ask  him  to  sell  us  something 
"good  for  a  headache  "  or  "  for  dyspepsia," 
"  something  to  give  one  an  appetite,"  "  some- 
thing to  make  me  sleep."  Or  we  buy  a  bot- 
tle of  patent  medicine,  a  kidney  plaster,  some 
cough  drops  or  an  "  electric  belt."  Should 
we  happen  to  dislike  medicines  there  are  the 
osteopaths  and  the  chiropractors,  the  mag- 
netic healers  and  the  hypnotists,  the  Christian 
Scientists  and  the  New  Thoughters,  any 
of  whom  will  take  our  case  in  hand  with 
alacrity. 

Moreover  all  these  men  and  manoeuvres 
are  cheaper  than  the  doctor,  and  since  the 
American  is  fond  of  bargains  in  every  depart- 
ment of  his  existence  and  forever  hopes  to 
get  "  as  good  an  article  for  less  money,"  he 
is  tolerant  and  credulous  with  all  health  fak- 
irs and  medical  short  cuts. 

Financial  rewards,  then,  are  not  compara- 
ble in  medicine  with  those  to  be  earned  in 

134 


REWARDS  OF  MEDICAL  WORK 

other  fields  by  men  of  equal  ability.  But 
far  worse  than  the  smallness  of  the  doctor's 
income  is  its  uncertainty.  A  grocer  can 
count  on  his  customers  to  a  considerable  ex- 
tent, since  every  one  must  eat  every  day. 
But  people  who  were  sick  last  year  cannot 
be  relied  upon  to  be  sick  again  next  year. 
Epidemics  of  typhoid  in  the  autumn  and  of 
scarlet  fever  in  the  spring  cannot  be  relied 
upon  as  in  the  days  when  all  health  boards 
were  ignorant  and  sleepy.  Some  health 
boards  are  now  active  enough  to  check  diph- 
theria or  smallpox,  and  the  number  of  such 
boards  is  steadily  though  slowly  increasing. 
Great  slices  may  at  any  time  be  cut  out  of  a 
doctor's  income  by  the  instalment  of  a  good 
water  supply,  a  pure  milk  supply,  or  an  ade- 
quate Pasteurization  system.  Even  the  anti- 
tuberculosis  crusade  and  the  campaign 
against  infant  mortality  have  begun  to  eat 
into  the  doctor's  returns.  School  hygiene, 
public  lectures  on  medical  topics,  newspaper 
publicity  on  the  methods  of  preserving 
health, — all  these  factors  are  not  only  for- 
midable but  incalculable.  One  can  have  no 

135 


TRAINING  OF  THE  PHYSICIAN 


confidence  that  next  year's  receipts  will  bear 
any  definite  relation  to  this  year's. 

The  only  way  out  of  this  difficulty  is  to  be- 
come a  salaried  health  officer,  an  office  not  yet 
desired  by  the  great  majority  of  physicians. 

I  have  known  few  physicians  fail  to  get  a 
living  in  medicine,  but  the  number  who  make 
comfortable  incomes  is  equally  few.  Some 
idea  of  the  incomes  of  Harvard  Medical 
graduates  can  be  gained  from  the  following 
figures  i1 

AVERAGE  EARNINGS 


Year  in 

Practice 

CLASSES 

1901 

1902 

1903 

1904 

1905 

1906 

1907 

1908 

1909 

1910 

1st. 

id..    . 

3d.. 

$866 
827 
1181 
1505 
2027 
2341 
2527 
3003 
3560 
3524 
3885 
4422 
4680 

$787 
1089 
1539 
1694 
1556 
1837 
2161 
2491 
2900 
2963 
3691 
4130 

$541 
790 
1412 
1720 
1966 
2333 
2654 
3155 
3616 
4135 
4604 

$362 
995 
1295 
1566 
1981 
2277 
2967 
3042 
3604 
4535 

$625 
773 
995 
1559 
1818 
2347 
3043 
3337 
4500 

$502 
826 
1262 
1765 
2359 
2997 
3650 
4332 

$350 
588 
1353 
1963 
2347 
3202 
3545 

$533 
1250 
1025 
1575 
1847 
2360 

$425 
874 
1370 
1632 
2150 

$1237 
1083 
1578 
1835 

4th. 
5th. 
6th. 
7th. 
8th. 
9th. 
10th. 
llth. 
12th. 
13th.   . 

Max.  no. 
of  men. 

38 

39 

29 

39 

S3 

26 

29 

29 

25 

26 

1  Loc.  cit.,  p.  60. 


136 


REWARDS  OF  MEDICAL  WORK 
GRATITUDE  AS  A  REWARD 

Another  reward  which  the  budding  doctor 
must  learn  not  to  expect  is  gratitude.  He 
also  gets  abuse  where  thanks  is  due.  He  is 
thanked  when  he  doesn't  deserve  it  and  left 
unthanked  when  he  does.  On  the  whole  he 
comes  out  about  square,  so  far  as  the  expres- 
sion of  gratitude  is  concerned.  His  service 
is  often  its  own  reward,  needing  no  expres- 
sion of  gratitude  in  words.  But  if  he  is  ex- 
pecting that  his  labors  will  be  duly  appreci- 
ated by  those  he  works  for  he  will  often  be 
disappointed. 

SUCCESS  IN  TREATMENT,  A  DUBIOUS  REWARD 

Sometimes  a  doctor  can  get  his  reward  in 
the  awareness  that  he  has  foiled  disease  and 
cured  his  patient.  But  if  he  is  honest  with 
himself  and  intelligent  about  the  respective 
roles  of  nature  and  man  in  the  cure  of  dis- 
ease, knowing  how  huge  is  the  contribution 
of  nature,  how  minute  the  efficacy  of  man 
and  his  remedies  in  all  except  a  few  of  the 

diseases  he  combats,  he  will  not  often  be  able 

13? 


TRAINING  OF  THE  PHYSICIAN 

to  say:  "  I  cured  him.  I  pulled  him 
through."  As  a  matter  of  fact  as  I  look 
back  on  twenty-five  years  of  medical  work 
I  can  remember  but  two  patients  whose  lives 
I  believe  I  saved.  Often  we  hope  that  our 
advice,  our  medicines  or  our  surgery  have 
had  a  good  effect,  perhaps  a  decisive  effect. 
But  when  we  read  medical  history  and  see 
how  often  our  grandfathers'  medicines  must 
have  done  harm,  how  often  the  patient  must 
(so  far  as  we  can  see)  have  recovered  in  spite 
of  treatment  rather  than  because  of  treat- 
ment, we  cannot  but  wonder  how  much  of  our 
present  up-to-date  therapeutics  will  appear 
useless  or  worse  than  useless  in  the  wise 
hindsight  of  our  grandchildren. 

Money,  gratitude,  and  technical  success, 
then,  cannot  be  our  rewards.  Let  us  look  in 
more  promising  directions. 

SOCIAL,  APPROVAL, 

This  is  a  medical  age.  Education,  phil- 
anthropy and  industry  are  deeply  tinctured 
by  medical  analogies  and  medical  ideals.  So- 

138 


REWARDS  OF  MEDICAL  WORK 

cial  workers  talk  about  "  social  diagnosis  " 
and  "  social  treatment"  Even  an  engineer 
is  apt  to  speak  of  the  "  diagnosis  "  of  the  bit 
of  natural  scenery  which  he  is  asked  to  make 
or  mar  with  a  bridge,  with  a  railroad  or  with 
an  aqueduct.  The  newspapers  are  full  of 
medical  items  and  medical  articles.  The 
difficulty  of  getting  medical  topics  discussed 
in  magazines  and  newspapers  has  now  been 
transformed  into  an  almost  uncanny  but  very 
positive  demand  on  the  part  of  these  agen- 
cies. Almost  any  medical  book  or  article 
can  get  itself  published.  On  this  evidence 
it  seems  to  me  fair  to  say  that  no  other  profes- 
sion excites  today  so  large  a  measure  of  pub- 
lic interest  in  all  classes.  For  our  age  is  es- 
pecially attuned,  both  by  its  strengths  and 
its  weaknesses,  to  understand  and  to  sympa- 
thize with  the  medical  point  of  view,  just  as 
it  is  fundamentally  out  of  tune  with  the  art- 
istic and  philosophic  interests  of  man. 

On  this  wave  of  public  interest  and  ap- 
proval, the  medical  profession  is  now  riding, 
either  for  good  or  evil  results.  I  am  clearly 
aware  both  of  the  good  and  the  harm  in  this 

139 


TRAINING  OF  THE  PHYSICIAN 

situation,  but  just  here  I  am  concerned  only 
with  its  advantages.  Few  people  of  us  real- 
ize, until  it  is  taken  away,  what  public  sym- 
pathy does  to  enhearten  us.  To  lose  it  and  to 
feel  that  the  world  is  against  us  is  one  of  the 
most  benumbing  and  paralysing  sensations 
in  the  world.  This  sensation,  to  some  extent, 
every  theologian  and  nearly  every  artist 
must  feel  today  in  America.  The  public  is  out 
of  sympathy  with  these  activities,  or  views 
them  with  more  or  less  amused  cynical  toler- 
ance. Of  course  this  indifference  does  not 
prevent  art  and  theology  from  ranking 
amongst  the  highest  things  that  a  man  can 
do.  Our  indifference  merely  proves  that 
they  are  today  out  of  fashion. 

On  the  other  hand,  to  be  in  fashion,  as 
medicine  today  is,  strengthens  the  resolves 
and  sharpens  the  wits  of  all  who  are  con- 
cerned in  it.  Our  medical  concerns  are 
everybody's  business,  partly  from  their  in- 
trinsic interest,  partly  because  everybody 
feels  that  he  may  be  a  patient  tomorrow. 
Nearly  everybody  is  aroused  by  the  interest 

140 


REWARDS  OF  MEDICAL  WORK 

of  medical  discoveries,  such  as  are  popping 
off  almost  daily  in  the  medical  press. 

One  of  the  rewards  of  medical  work,  then, 
is  public  sympathy  and  approval, — if  not 
with  my  particular  deeds  or  yours,  still  with 
the  endeavor  which  medical  men  represent 
and  the  hopes  which  we  cherish. 

MEDICINE  USES  ALL  HUMAN  POWER 

A  more  durable  reward  results  from  the 
fact  that  medical  work  is  more  prone  than 
any  work  that  I  know  of  to  engage  all  the 
resources  of  a  human  being.  It  calls  out  all 
our  powers.  Although  in  one  sense  medicine 
is  a  specialty,  in  a  more  important  sense,  it 
is  a  profession  which  can  use  the  whole  of  a 
man  as  no  other  profession  can.  Thus  it 
keeps  us  young.  The  powers  that  are  trained 
in  wood-craft  and  in  athletics  ordinarily  lie 
dormant  and  gradually  degenerate  after  a 
young  man  has  tied  himself  into  the  harness 
of  his  profession.  He  gets  fat,  butter-fing- 
ered, and  footless.  The  keenness  of  his  sight 
and  hearing,  the  deftness  of  his  Han'd,  the 
effective  application  of  his  most  powerful 

141 


TRAINING  OF  THE  PHYSICIAN 

muscles,  all  die  out  when  he  must  follow  the 
calling  of  the  minister,  the  lawyer,  the  finan- 
cier, or  the  teacher. 

In  medicine,  on  the  other  hand,  we  need 
and  train  all  the  powers  of  our  senses.  A 
physician's  eye  cannot  be  too  sharp,  his  pow- 
ers to  seek  and  to  find  cannot  be  too  well 
trained  for  the  work  that  he  has  to  do  with 
the  microscope  or  the  scalpel.  In  the  exam- 
ination of  blood  or  of  the  substance  coughed 
up  from  the  lungs,  in  the  search  for  bacteria, 
in  the  diagnosis  between  benign  and  malig- 
nant tumors,  and  last  but  most  of  all  in  the 
study  of  the  patient's  physiognomy,  he  needs 
and  uses  all  the  power  that  as  a  skillful  hunts- 
man or  woodsman  he  may  have  acquired  in 
his  younger  days.  A  lawyer  or  a  minister 
has  little  use  for  swift,  accurate  movements, 
nor  for  the  more  violent  muscular  efforts 
which  are  developed  in  football  or  baseball. 
But  a  doctor  has  constant  use  for  them. 
When  he  is  measuring  blood  pressure,  when 
he  is  testing  nerve  and  muscle  reflexes,  when 
he  practices  any  department  of  surgery,— 
above  all  when  he  takes  his  part  in  aiding  so 

142 


REWARDS  OF  MEDICAL  WORK 

far  as  he  can  the  labor  of  a  woman  in  child- 
birth— the  physician  may  need  all  the  mus- 
cular strength,  all  the  manual  skill  and  knack 
that  in  his  younger  days  he  may  have  ac- 
cumulated when  he  lived,  worked,  and 
played  out  of  doors.  What  use  has  a  finan- 
cier or  a  manufacturer  for  special  keenness 
of  touch  or  hearing?  Any  keenness  of  hear- 
ing that  he  has  learned  in  woodcraft  or  in 
music  goes  for  nothing  in  the  practice  of  his 
profession.  But  the  doctor's  ears  can  never 
be  too  keen  to  identify  and  distinguish 
sounds  which  he  hears  through  the  stetho- 
scope in  the  heart  or  lungs  of  his  patient. 

Now  if  it  is  true,  as  I  believe,  that  human 
happiness  consists  to  a  considerable  extent, 
in  our  opportunity  to  use,  not  only  one  or 
two  of  our  powers  but  all  of  them,  then  surely 
it  is  one  of  the  greatest  rewards  of  medicine 
that  not  only  our  brains  but  our  senses,  or 
muscles,  and  our  co-ordinations  can  be  put 
at  the  service  of  our  patients  and  made  of 
value  in  our  professional  work. 

It  keeps  us  supple  in  mind  and  spirit  to 
use  every  faculty  that  we  possess,  to  take  in 

143 


TRAINING  OF  THE  PHYSICIAN 

at  every  pore  the  typical  human  experiences 
as  we  meet  them  in  men,  women  and  children, 
in  the  rich  and  in  the  poor,  in  the  well  mem- 
bers of  the  patient's  family  as  well  as  in  the 
sufferer  himself.  Familiarity  with  the  Jew 
and  the  Gentile,  with  the  Italian,  the  Irish- 
man, and  the  Negro,  all  coming  in  the  course 
of  our  regular  work,  tends  to  awaken  and  to 
exercise  the  interests  which  in  many  a  pro- 
fessional life  must  lie  unused.  In  banking 
one  meets  chiefly  men;  in  the  dry  goods  busi- 
ness chiefly  women.  In  teaching  one  comes 
in  contact  with  only  a  single  stratum  of 
youth.  College  teachers  get  the  impression, 
they  tell  me,  that  the  whole  human  race  con- 
sists of  boys  between  eighteen  and  twenty- 
two.  This  may  be  altogether  too  easy  or  it 
may  be  distressingly  irksome,  according  to 
the  temperament  that  faces  it;  but  in  any 
case  it  is  narrowing  and  cramping. 

THE  PHYSICIAN,  A  PEACE  MAKER 

A  third  and  most  signal  reward  of  medical 
work  is  this :  we  carry  with  us  a  flag  of  truce 
in  all  the  wars  that  divide  man  from  man.  In 

144 


REWARDS  OF  MEDICAL  WORK 

bitter  political  contests  one  may  be  the  phy- 
sician and  so  the  intimate  friend  of  combat- 
ants on  both  sides.  The  disputes  between 
labor  and  capital  do  not  prevent  the  doctor 
from  being  intimate  with  members  of  each 
group,  who  forget,  in  relation  to  him,  their 
"  class-consciousness.'*  I  have  been  told  that, 
in  one  of  the  labor  wars  of  Colorado,  when 
the  strikers  were  put  in  the  "  bull  pen,"  the 
only  persons  who  passed  freely  from  the  out- 
side to  the  inside  of  that  stockade  were  the 
physicians.  In  the  present  world-devastating 
struggle  of  Europe,  it  is  only  the  physicians 
and  nurses  who  can  work  alike  for  the  Allies 
and  for  their  enemies. 

This  advantage  goes  far  beyond  the  do- 
main of  friendly  feeling.  It  gives  us 
harvests  of  deeper  knowledge  and  so  of 
greater  powers;  for  it  is  in  the  atmosphere 
of  friendliness  that  we  are  enabled  to  get 
close  to  the  true  facts  of  any  man's  or  any 
woman's  personality.  Hostility  shuts  us  out, 
not  only  from  the  reaches  of  good  feeling,  but 
from  contact  with  the  genuine  facts  and 
forces  that  make  up  the  other  man. 

10  145 


TRAINING  OF  THE  PHYSICIAN 

AN  OPPOBTUNITY  TO  TEACH 

George  Meredith  has  said  that  there  lives 
a  school  master  somewhere  in  the  breast  of 
every  man.  We  all  have  a  latent  desire 
to  teach  somebody  something.  No  physician 
lacks  this  opportunity.  He  need  not  be  a 
professor.  His  patients  always  look  to  him 
for  instruction;  indeed,  they  almost  force  it 
out  of  him.  The  physician's  tiniest  talents 
for  instruction  are  thus  nursed  into  life  and 
energy  by  his  sense  of  a  real  need  for  what 
he  has  to  teach. 

This  part  of  medical  work  grows  more  and 
more  important  every  day,  for  preventive 
medicine,  the  livest  of  modern  hopes,  is  built 
up  not  only  through  public  instruction,  but 
especially  through  the  lessons  passed  on  in- 
dividually by  doctors  to  their  patients  and 
through  them  to  families  and  neighborhoods. 
Moreover,  the  kind  of  teaching  that  doctors 
do  is  that  which  brings  most  satisfaction  to 
teacher  and  pupil.  It  approaches  the  ideal, 
exemplified  in  Dickens'  "  Nicholas  Nick- 
elby,"  when  Squeers  says  to  his  pupils: 
"  W-i-n-d-e-r:  winder,  now  go  clean  it." 

146 


REWARDS  OF  MEDICAL  WORK 

Theory  is  put  into  practice  at  once.  Instruc- 
tion initiates  action  and  is  winnowed  in 
action.  You  are  never  long  in  doubt  as  to 
whether  your  pupil  understands  you  or  not, 
for  what  he  does  within  the  next  day  or  two 
will  make  it  plain.  Could  any  teacher  ask  a 
better  opportunity:  Is  this  not  the  type  of 
teaching  which  all  who  follow  that  calling 
long  for? 

MEDICINE  NOURISHES  EVEN  THE  TINIEST 
TALENTS  FOR  SCIENCE 

The  rewards  that  I  have  pointed  out  so 
far — the  ability  to  conserve  the  talents  of 
youth  in  the  facilities  of  sense  and  muscle, 
the  opportunity  to  get  friendly  with  all  sorts 
of  conditions  of  men,  women  and  children, 
the  chance  to  cut  across  the  enmities  and 
divisions  of  men  with  a  flag  of  truce,  the  call 
to  the  teacher  latent  in  most  of  us — all  these 
are  but  half  the  blessings  of  being  a  doctor, 
for  they  all  lie  upon  one  side  of  that  division 
which  separates  our  activities  into  the  arts  and 
crafts  upon  one  side  and  the  scientific  inter- 
ests on  the  other.  Not  all  of  us  have  any 

147 


TRAINING  OF  THE  PHYSICIAN 

real  bent  for  science, — not  all  even  of  those 
who  call  themselves  doctors.  But  I  think  it 
is  safe  to  say  that  if  anything  will  rouse  a 
man's  interest  in  the  pursuit  of  truth,  if 
anything  will  lure  a  scrap  of  scientific  in- 
terest out  of  his  breast,  it  is  medical  work. 
A  physician  is  almost  forced  to  take  an  in- 
terest in  the  truth  that  he  learns  from  day  to 
day  in  the  souls  and  bodies  of  men.  He  can 
hardly  escape  being  drawn  out  of  the  field 
of  merely  practical  or  merely  financial  in- 
terest, into  the  disinterested  pursuit  of  truth, 
at  any  rate,  for  a  few  minutes  a  day.  For 
medical  progress  is  so  rapid  and  so  ob- 
viously useful,  its  applications  are  so  many 
and  so  grateful,  that  its  science  soon  ceases 
to  seem  the  cold  and  inhuman  pursuit  which 
to  many  it  now  appears.  To  be  able  to 
practice  a  profession  in  which  the  pursuit  of 
truth  pays,  and  pushes  itself  under  our  very 
noses  in  the  midst  of  our  utilitarian  and 
money  making  activities,  is  surely  a  great 
reward. 

THE    CHANCE    TO   LEAD 

Another  reward  of  medical  work  is  its 
opportunity  for  the  exercise  of  authority  and 

148 


REWARDS  OF  MEDICAL  WORK 

leadership.  Patients  and  their  families  often 
go  to  the  doctor  for  guidance,  confide  in  him 
their  intimate  and  sacred  concerns  as  to  no 
one  else  in  the  community.  Not  even  the 
minister  of  religion  hears  such  confessions 
and  gets  the  opportunities  to  apply  such  com- 
mon sense  and  idealism  as  he  may  possess  to 
the  straightening  out  of  human  difficulties. 
Many  of  us  have  no  instinctive  desire  to  be 
the  recipient  of  personal  confidences  or  to 
be  looked  to  for  guidance  in  such  crucial  mat- 
ters. Yet  as  we  settle  into  the  maturer  activ- 
ities of  our  working  life,  I  think  there  grows 
up  in  most  of  us  a  more  or  less  honorable 
desire  to  influence  by  advice  and  guidance  the 
course  of  human  affairs.  Bentham  taught 
that  in  democracy  everybody  should  count  as 
one,  nobody  as  more  than  one.  In  the  ulti- 
mate test  of  ballot-casting,  on  election  day 
when  the  campaign  is  over,  Bentham's  rule 
is  doubtless  correct.  But  except  on  election 
day  this  ideal  has  little  place.  Men  and 
especially  women  will  always  and  should 
always  follow  leaders.  The  right  to  lead, 
not  by  an  arbitrary  advantage  of  place  and 

149 


TRAINING  OF  THE  PHYSICIAN 

power,  but  by  the  possession  of  knowledge 
or  skill  in  some  particular  field  of  endeavor, 
is  a  deeply  human  right — one  that  should  be 
possessed  somewhere,  sometimes  and  in  some 
degree  by  every  man  and  woman.  Even  the 
child  is  often  rightfully  our  leader,  as  Christ 
taught  us. 

This  right  of  leadership  is  at  any  rate 
desired,  for  good  reasons  or  for  bad,  by  almost 
everyone.  In  vulgar  parlance,  we  like  to  be 
able  to  "  swing  things  "  and  to  have  the  cast- 
ing vote  in  decisions  of  importance.  In  medi- 
cine such  responsibilities  come  to  us  naturally 
and  inevitably.  We  are  consulted  about 
family  quarrels,  about  family  expenditures, 
about  the  problems  of  education  and  moral 
guidance,  the  problems  of  sex  and  honor, 
which  are  mixed  inextricably  with  the  phys- 
ical make-up  of  those  for  whom  we  work. 

Of  course  no  man  is  fit  to  be  a  leader  in 
so  many  struggles.  No  one  is  an  expert  or 
an  authority  in  such  diverse  fields.  But 
where  so  many  commands  are  offered  it 
should  be  possible  with  modesty,  yet  with 
self-respect,  to  accept  some  that  are  within 

150 


our  competence.  Moreover,  when  all  the 
superior  officers  are  dead  or  absent,  even  a 
second  lieutenant  may  be  forced  to  lead. 

For  anyone  who  has  developed,  either  in 
college  or  later,  an  interest  in  the  most  im- 
portant, the  most  vital,  the  most  practical  of 
all  life  problems — those  of  philosophy  and 
of  religion,  it  is  surely  a  great  reward  to  be 
given  the  opportunity  to  apply  what  he  be- 
lieves in  a  way  to  help  human  beings  in 
trouble.  We  may  think,  while  in  college  class 
rooms,  that  it  makes  no  concrete  difference 
how  we  settle  or  desert  the  problems  of 
free  will,  theism  or  immortality.  But  in 
medicine  these  problems  are  thrust  upon  us, 
urgent  as  a  bleeding  wound.  They  need 
immediate  attention,  immediate  solution,  so 
far  as  we  have  any  power  to  solve  them  or 
to  help  in  that  direction.  Not  a  week  passes 
in  the  practice  of  the  ordinary  physician  but 
he  is  consulted  about  one  or  more  of  the  deep- 
est problems  in  metaphysics  and  religion — 
not  as  a  speculative  enigma,  but  as  part  of 
human  agony. 

It  may  be  that  one  has  decided,  once  for 

151 


TRAINING  OF  THE  PHYSICIAN 

all,  to  turn  aside  from  these  questions,  to  live 
upon  the  surface  of  life  and  risk  its  catac- 
lysmic shocks,  unprepared.  But  if  one  has 
any  desire  to  go  to  the  bottom  of  things,  to 
be  thorough  instead  of  superficial  in  one's 
dealings  with  man,  fate  and  nature,  then 
medicine  gives  one  an  unparalleled  oppor- 
tunity for  the  development  of  such  powers. 


If  there  is  any  power  that  a  doctor  does 
not  need  in  his  business,  I  do  not  know  it. 
If  there  is  any  man  who  can  say  with  earnest- 
ness that  he  "  counts  nothing  human  foreign 
to  him"  then  surely  medicine  is  the  job  for 
him,  the  path  along  which  he  can  find  the 
goal  of  his  desire.  For  nothing  human  is 
foreign  to  the  work  of  a  doctor — not  the 
lowest  or  the  highest  in  our  nature,  not  the 
best  or  the  worst,  the  most  realistic  and 
minute,  not  the  most  scientific  and  modern, 
not  the  most  classical  and  permanent.  All 
these  summon  the  physician  to  stand  upon  his 
feet  and  make  his  contribution  before  he  dies. 
All  contribute  to  his  reward. 

152 


REWARDS  OF  MEDICAL  WORK 

The  physician  is  the  child  of  his  age.  Such 
an  opportunity  as  a  great  painter  had  in  the 
Renaissance  or  a  great  musician  had  in  the 
early  years  of  the  19th  century,  a  physician 
has  to-day.  The  scientific  and  mechanical, 
the  utilitarian  and  practical  eagerness  of  our 
age,  finds  an  outlet  in  him.  But  the  deeper 
and  more  permanent  hungers  of  the  human 
race,  to  search  for  truth  and  to  spread  it,  to 
love  and  serve  our  fellows  and  to  know  God, 
also  find  their  natural  expression  and  devel- 
opment in  the  practice  of  medicine.  It  is 
not  a  lucrative  pursuit.  It  brings  few  to 
fame  and  renown.  It  is  hard  work,  never 
finished  in  any  eight  or  eighteen  hours  a  day. 
But  its  rewards,  as  I  see  them,  are  beyond 
those  of  any  other  profession. 


153 


Date  Due 


1961 


A     000510010     2 


W  21 

Cll6t 
1918 
Cabot,  Richard  C 

Training  and  rewards  of  the 

physician 


W  21 
Cll6t 

1918 
Cabot,  Richard  C 

Training  and  rewards  of  the  physician 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 
IRVINE,  CALIFORNIA  92664 


